NPIMap

Organization Active NPI

Madison Dental Group, PLLC

  • Dental Clinic/Center
  • Madison, MS
National Provider Identifier
1760106199
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
MADISON DENTAL GROUP, PLLC
Practice address
7731 Old Canton Rd Ste a
Madison, MS 39110-6115
Phone
(601) 853-3565
Fax
(601) 853-3598
NPI assigned
Sep 29, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Authorized official

Name
William Coleman Fortenberry, DMDNPI 1417009200
Title
Owner
Phone
(601) 853-3565

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

7731 Old Canton Rd Ste a
Madison, MS 39110-6115

Mailing address

PO Box 1547
Madison, MS 39130-1547
Phone (601) 853-3565

Other names 1

  • Madison Dental Group Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address officemanager@madisondentalgroup.org Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1664409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1760106199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1547",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391301547",
            "telephone_number": "601-853-3565",
            "fax_number": "601-853-3598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7731 OLD CANTON RD STE A",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106115",
            "telephone_number": "601-853-3565",
            "fax_number": "601-853-3598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON DENTAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-29",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "FORTENBERRY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "COLEMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-853-3565",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "officemanager@madisondentalgroup.org",
            "affiliation": "N",
            "endpointDescription": "emal",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7731 Old Canton Rd Ste A",
            "city": "Madison",
            "state": "MS",
            "country_code": "US",
            "postal_code": "391106115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Madison Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Madison Dental Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.