Gerald Dodd Brister Jr., D.D.S.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Pearl, MS
NPI 1720154180 · NPPES record last updated Sep 2, 2010
Key facts
- NPI
- 1720154180
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 2662 (MS)
- Practice address
- 3007 Greenfield Rd
Pearl, MS 39208-8712 - Phone
- (601) 824-5878
- NPI assigned
- Nov 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2662 | MS | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| G. Dodd Brister, Jr., DDS, PA | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2662 | MS | Yes |
Addresses
Primary practice location
3007 Greenfield Rd
Pearl, MS 39208-8712
Mailing address
3007 Greenfield Rd
Pearl, MS 39208-8712
Other providers in Pearl, MS
- David E Bozone Jr.
- Brandon Physician Management LLC
- Louis J Breland
- Brian S Callahan O.D. Inc.
- Brighter Days Adult Day Care LLC
- Amy Brown
- Lorin Jessica Brown
- Romesha Deshawn Brown
- Hannah Dye Browning
- Bryant Physical Therapy and Wellness
All providers in Pearl, MS · Orthodontics and Dentofacial Orthopedics Dentistry in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.