Leaf River Dental, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LEAF RIVER DENTAL, PLLC

Practice address

1115 Evelyn Gandy Parkway
Petal, MS 39465

Phone

(601) 271-8710

NPI assigned

Jun 15, 2020

Last updated

Jun 15, 2020By 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. Lanthea Mangum

Title

Coo

Phone

(601) 271-8710

Specialties & licenses 1

Addresses

Locations

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.

• Hunter Hawkins, DMD

  • General Practice Dentistry
  • Petal, MS
  • NPI 1306454848
  NPD

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

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592179200000",
    "number": "1750906707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4358 LINCOLN ROAD EXT STE 20",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023275",
            "telephone_number": "601-271-8710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 EVELYN GANDY PARKWAY",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "39465",
            "telephone_number": "601-271-8710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAF RIVER DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-15",
        "last_updated": "2020-06-15",
        "certification_date": "2020-06-15",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "LANTHEA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "601-271-8710",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krista King, RDN, LD
• Kipa Inc. Dba Rodgers Family Pharmacy
• Zachary Bruce Kulzer, DPT, PT
• Landas Healthcare Service
• Erin Lazenby, CPNP
• Latosha Lees
• Life Construction Outreach (JRCS)
• Amye B Lovitt, DPT
• Rodney N Lovitt, MD
• Stacy L Lowery, PHARM.D.

• Dental Clinic/Center in Petal, MS
• Providers in Petal, MS by specialty
• Dental Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.