Individual provider Active NPI

Dustin Pambianchi, DMD

  • General Practice Dentistry
  • Lexington, MS
National Provider Identifier
1730591983
Registry record updated Sep 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3741-14 Issued in MS
Practice address
302 Court SQ
Lexington, MS 39095-3630
Phone
(662) 834-9899
NPI assigned
May 22, 2014
Last updated
Sep 29, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3741-14 MS Primary

Addresses

Primary practice location

302 Court SQ
Lexington, MS 39095-3630

Mailing address

302 Court SQ
Lexington, MS 39095-3630

Other identifiers 1

IdentifierTypeStateIssuer
05436359MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3741-14MSMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Heather Killebrew Tutor, DMD, PA Past Accepting new patients
Lexington Dental, PLLC PastSince Jun 28, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443484800000",
    "number": "1730591983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 COURT SQ",
            "city": "LEXINGTON",
            "state": "MS",
            "postal_code": "390953630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 COURT SQ",
            "city": "LEXINGTON",
            "state": "MS",
            "postal_code": "390953630",
            "telephone_number": "662-834-9899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAMBIANCHI",
        "first_name": "DUSTIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-22",
        "last_updated": "2015-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3741-14",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05436359",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2015; 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.