Southern Orthodontic Specialists, P.C.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

1154-64 Issued in MS

Legal business name

SOUTHERN ORTHODONTIC SPECIALISTS, P.C.

Practice address

7732 Airways Blvd
Southaven, MS 38671-5306

Phone

(662) 349-0777

Fax

(662) 349-0782

NPI assigned

Feb 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. David R Libby, DDS, MSNPI 1194056648

Title

Orthodontist

Phone

(662) 349-0777

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Ray Libby, D.D.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Southaven, MS
  • NPI 1194056648
  NPD (past) Authorized official
• Hunter B Harrison, D.D.S., M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Southaven, MS
  • NPI 1336470277
  NPD (past)

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801921614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7732 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715306",
            "telephone_number": "662-349-0777",
            "fax_number": "662-349-0782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7732 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715306",
            "telephone_number": "662-349-0777",
            "fax_number": "662-349-0782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ORTHODONTIC SPECIALISTS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LIBBY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ORTHODONTIST",
        "authorized_official_telephone_number": "662-349-0777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MS",
            "license": "1154-64",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Southaven, MS
• Providers in Southaven, MS by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.