Polk Dental Center

Primary specialty

DentistTaxonomy code 122300000X

License

3137 Issued in MS

Legal business name

POLK DENTAL CENTER

Practice address

120 Scarbrough St
Suite B
Richland, MS 39218-9770

Phone

(601) 932-0606

Fax

(601) 932-0703

NPI assigned

Jul 24, 2007

Last updated

Jul 24, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Nicki Ashley

Title

Office Manager

Phone

(601) 932-0606

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

Practitioners 2

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.

• Jason L Polk, D. M. D

  • General Practice Dentistry
  • Richland, MS
  • NPI 1033131487
  NPD (past)
• Lexi A. Polk, D.M.D

  • General Practice Dentistry
  • Richland, MS
  • NPI 1447272802
  NPD (past)

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

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185235200000",
    "number": "1750581906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 180607",
            "city": "RICHLAND",
            "state": "MS",
            "postal_code": "392180607",
            "telephone_number": "601-932-0606",
            "fax_number": "601-932-0703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SCARBROUGH ST",
            "address_2": "SUITE B",
            "city": "RICHLAND",
            "state": "MS",
            "postal_code": "392189770",
            "telephone_number": "601-932-0606",
            "fax_number": "601-932-0703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2007-07-24",
        "status": "A",
        "authorized_official_last_name": "ASHLEY",
        "authorized_official_first_name": "NICKI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "601-932-0606",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3137",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3138",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016079",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashton Phillips
• Phoenix Healthcare, LLC
• Phoenix Specialtycare, LLC
• Physical Rehabilitation Management (Richland Physical Therapy)
• Jaycee Sue Pilcher
• James D Polk, M.D.
• Jason L Polk, D. M. D
• Lexi A. Polk, D.M.D
• Teresa Polk, CFNP
• Polk's Crossgate Discount Drugs Inc. (Polk's Discount Drugs #5)

• Dentist in Richland, MS
• Providers in Richland, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; 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.