Greenville Dental Clinic

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2893-95 Issued in MS

Legal business name

GREENVILLE DENTAL CLINIC

Practice address

1391 E Reed Rd
Greenville, MS 38703-7234

Phone

(662) 332-9011

Fax

(662) 332-9012

NPI assigned

Apr 8, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Eustace H Winn III, D.M.D.NPI 1023102274

Title

Owner

Phone

(662) 332-9011

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Eustace Harold Winn III, DMD

  • General Practice Dentistry
  • Greenville, MS
  • NPI 1023102274
  NPD (past) Authorized official

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

{
    "created_epoch": "1302220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302220800000",
    "number": "1932499241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1391 E REED RD",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037234",
            "telephone_number": "662-332-9011",
            "fax_number": "662-332-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1391 E REED RD",
            "city": "GREENVILLE",
            "state": "MS",
            "postal_code": "387037234",
            "telephone_number": "662-332-9011",
            "fax_number": "662-332-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-08",
        "last_updated": "2011-04-08",
        "status": "A",
        "authorized_official_last_name": "WINN",
        "authorized_official_first_name": "EUSTACE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-332-9011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2893-95",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00660177",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lemarrick Green, MHT
• Nellie Green
• Greenville Ambulatory Surgery Center, LLC (Greenville Ambulatory Surgery Center)
• Greenville Assisted Living
• Greenville Chiropractic Clinic, Inc
• Greenville Eye Clinic P.a.
• Greenville Family Clinic Inc (Greenville Family Clinic)
• Greenville Family Medical Center Inc (Family Medical Center)
• Greenville Hem-Onc PC
• Greenville Neuro Diagnostic Center, P.C.

• General Practice Dentistry in Greenville, MS
• Providers in Greenville, 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 Apr 8, 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.