South Jackson Family Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2940-96MS Issued in MS

Legal business name

SOUTH JACKSON FAMILY DENTAL, PLLC

Practice address

5643 Highway 18 W
Suite G
Jackson, MS 39209-9529

Phone

(601) 922-0056

NPI assigned

Jul 25, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Lake Garner, DMD

Title

Owner

Phone

(601) 271-8710

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406246400000",
    "number": "1821406570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18560",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394048560",
            "telephone_number": "601-271-8710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5643 HIGHWAY 18 W",
            "address_2": "SUITE G",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392099529",
            "telephone_number": "601-922-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH JACKSON FAMILY DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-25",
        "last_updated": "2014-07-25",
        "status": "A",
        "authorized_official_last_name": "GARNER",
        "authorized_official_first_name": "LAKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-271-8710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2940-96MS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonny Montgomery V a M Edical Center
• Lisa Allegrezza Sorey
• Mary Louise Sorey, M.S.,CCC-SLP
• Tina Renee Sorey, O.D.
• South Central Community Action Agency, Inc
• Southeast Urogyn LLC
• Southeast Urogynecology PA
• Southern Christian Services for Children and Youth, Inc.
• Southern Counseling Center
• Southern Home Care Services, Inc.

• General Practice Dentistry in Jackson, MS
• Providers in Jackson, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2014; 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.