Mid Town Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

294096 Issued in MS

Legal business name

MID TOWN DENTAL

Practice address

808 N State St
Suite a
Jackson, MS 39202-2602

Phone

(601) 355-5275

NPI assigned

Feb 13, 2014

Organization subpart

No

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

Authorized official

Name

Stevey Gaddis

Title

Office Manager

Phone

(601) 355-5275

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1392249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392249600000",
    "number": "1861816670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022602",
            "telephone_number": "601-355-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 N STATE ST",
            "address_2": "SUITE A",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392022602",
            "telephone_number": "601-355-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID TOWN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-13",
        "last_updated": "2014-02-13",
        "status": "A",
        "authorized_official_last_name": "GADDIS",
        "authorized_official_first_name": "STEVEY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "601-355-5275"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "294096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ericka M Micou, NP
• Mid Jackson Family Health Clinic
• Mid Jackson Family Health Clinic
• Mid South Dental Center of Jackson
• Mid State Artificial Limb Co, Inc
• Middle Ms Access Corporation
• Adam Middleton
• Alyssa Downing Middleton, M.D.
• Brennen Michael Middleton, MD
• Charles Hunter Middleton

• 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 Feb 13, 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.