NPIMap

Organization Active NPI

Nettleton Dental LLC

  • Dental Clinic/Center
  • Nettleton, MS
National Provider Identifier
1780303677
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
NETTLETON DENTAL LLC
Practice address
228 Main St
Nettleton, MS 38858-6012
Phone
(662) 963-7338
NPI assigned
Aug 24, 2022
Last updated
Aug 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Dr. Ambrie Goodman, DMDNPI 1023468659
Title
Dentist
Phone
(662) 571-8760

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

228 Main St
Nettleton, MS 38858-6012

Mailing address

228 Main St
Nettleton, MS 38858-6012
Phone (662) 963-7338

National Provider Directory

National Provider Directory

Locations

228 Main St
Nettleton, MS 38858
Phone (662) 963-7338

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1780303677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "228 MAIN ST",
            "city": "NETTLETON",
            "state": "MS",
            "postal_code": "388586012",
            "telephone_number": "662-963-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 MAIN ST",
            "city": "NETTLETON",
            "state": "MS",
            "postal_code": "388586012",
            "telephone_number": "662-963-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NETTLETON DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "AMBRIE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "662-571-8760",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nettleton, MS

Sources for this page

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