NPIMap

Organization Active NPI

Periodontal Associates of Jackson, P.a.

  • Periodontics
  • Jackson, MS
National Provider Identifier
1790069854
Registry record updated Oct 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
1845-79 Issued in MS
Legal business name
PERIODONTAL ASSOCIATES OF JACKSON, P.A.
Practice address
406 Briarwood Dr.
Ste. 101
Jackson, MS 39206
Phone
(601) 956-1230
Fax
(601) 956-0201
NPI assigned
Oct 6, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2011

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

Authorized official

Name
Roger B. Parkes, D.M.D.NPI 1598974867
Title
Owner/Dentist
Phone
(601) 956-1230

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X 1845-79 MS Primary
PeriodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0300X 2364-87 MS

Addresses

Primary practice location

406 Briarwood Dr.
Ste. 101
Jackson, MS 39206

Mailing address

406 Briarwood Dr.
Ste. 101
Jackson, MS 39206
Phone (601) 956-1230

National Provider Directory

National Provider Directory

Locations

406 Briarwood Dr
Ste 101
Jackson, MS 39206
Phone (601) 956-1230

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": "1317859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317859200000",
    "number": "1790069854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 BRIARWOOD DR.",
            "address_2": "STE. 101",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39206",
            "telephone_number": "601-956-1230",
            "fax_number": "601-956-0201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 BRIARWOOD DR.",
            "address_2": "STE. 101",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39206",
            "telephone_number": "601-956-1230",
            "fax_number": "601-956-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERIODONTAL ASSOCIATES OF JACKSON, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-06",
        "last_updated": "2011-10-06",
        "status": "A",
        "authorized_official_last_name": "PARKES",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "601-956-1230",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MS",
            "license": "1845-79",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "MS",
            "license": "2364-87",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; 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.