NPIMap

Organization Active NPI

Collins Family Dental Care

  • General Practice Dentistry
  • Collins, MS
National Provider Identifier
1730265083
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
COLLINS FAMILY DENTAL CARE
Practice address
103 S. Fir Street
Collins, MS 39428
Phone
(601) 765-4355
Fax
(601) 765-4745
NPI assigned
Oct 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2020

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

Authorized official

Name
Mr. Roger Kyle BassNPI 1770669020
Title
Co-Owner
Phone
(601) 765-4355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

103 S. Fir Street
Collins, MS 39428

Mailing address

P.O. Box 1508
Collins, MS 39428
Phone (601) 765-4355

Other names 1

  • Bishop & Bass, PA Former legal business name

National Provider Directory

National Provider Directory

Locations

103 S Fir Ave
Collins, MS 39428
Phone (601) 765-4355

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1730265083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1508",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "39428",
            "telephone_number": "601-765-4355",
            "fax_number": "601-765-4745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S. FIR STREET",
            "city": "COLLINS",
            "state": "MS",
            "postal_code": "39428",
            "telephone_number": "601-765-4355",
            "fax_number": "601-765-4745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINS FAMILY DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-30",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "601-765-4355",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bishop & Bass, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Collins, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; 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.