NPIMap

Organization Active NPI

Forest Dental Practice PLLC

  • General Practice Dentistry
  • Forest, MS
National Provider Identifier
1861542433
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
09015012 Issued in MS
Legal business name
FOREST DENTAL PRACTICE PLLC
Practice address
PO Drawer 30
Forest, MS 39074
Phone
(601) 469-3851
Fax
(601) 469-4356
NPI assigned
Jan 12, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
John B Smith, DMDNPI 1306996970
Title
Owner
Phone
(601) 469-3851

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 09015012 MS Primary

Addresses

Primary practice location

PO Drawer 30
Forest, MS 39074

Mailing address

PO Box 30
Forest, MS 39074-0030
Phone (601) 469-3851

Other identifiers 1

IdentifierTypeStateIssuer
09015012MedicaidMS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861542433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "390740030",
            "telephone_number": "601-469-3851",
            "fax_number": "601-469-4356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO DRAWER 30",
            "city": "FOREST",
            "state": "MS",
            "postal_code": "39074",
            "telephone_number": "601-469-3851",
            "fax_number": "601-469-4356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST DENTAL PRACTICE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-469-3851",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "09015012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015012",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, MS

Sources for this page

  • 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.