NPIMap

Organization Active NPI

Metro Dental Inc

  • Dentist
  • Jackson, MS
National Provider Identifier
1720390693
Registry record updated Jul 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
METRO DENTAL INC
Practice address
1836 Crane Ridge Dr
Jackson, MS 39216-4901
Phone
(601) 862-2752
NPI assigned
Jul 8, 2010
Last updated
Jul 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jim Polles, MP PANPI 1669482014
Title
Owner
Phone
(601) 862-2752

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

1836 Crane Ridge Dr
Jackson, MS 39216-4901

Mailing address

1836 Crane Ridge Dr
Jackson, MS 39216-4901
Phone (601) 862-2752

National Provider Directory

National Provider Directory

Locations

1836 Crane Ridge Dr
Jackson, MS 39216
Phone (601) 862-2752

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278547200000",
    "number": "1720390693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 CRANE RIDGE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164901",
            "telephone_number": "601-862-2752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1836 CRANE RIDGE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164901",
            "telephone_number": "601-862-2752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METRO DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-08",
        "last_updated": "2010-07-08",
        "status": "A",
        "authorized_official_last_name": "POLLES",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-862-2752",
        "authorized_official_credential": "MP PA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.