Dental Group of Ellisville, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2940-96 Issued in MS

Legal business name

DENTAL GROUP OF ELLISVILLE, PLLC

Practice address

97 Hal Crocker Road
Ellisville, MS 39437

Phone

(601) 477-3779

Fax

(601) 477-3770

NPI assigned

Aug 27, 2012

Last updated

Mar 18, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Terry Lake Garner, DMD

Title

Owner

Phone

(601) 271-8710

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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.

• Weslie Ann Blackledge, DMD

  • General Practice Dentistry
  • Ellisville, MS
  • NPI 1285565366
  NPD (past)
• Alecia A Moore, DMD

  • General Practice Dentistry
  • Ellisville, MS
  • NPI 1114289394
  NPD (past)

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

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552867200000",
    "number": "1972851814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 HAL CROCKER ROAD",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "39437",
            "telephone_number": "601-477-3779",
            "fax_number": "601-477-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 HAL CROCKER ROAD",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "39437",
            "telephone_number": "601-477-3779",
            "fax_number": "601-477-3770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL GROUP OF ELLISVILLE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-27",
        "last_updated": "2019-03-18",
        "status": "A",
        "authorized_official_last_name": "GARNER",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "LAKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-271-8710",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2940-96",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00660377",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dominique Common
• William Currie, M.D.
• Joseph R Danford, MD
• Jimmy L. Darby, KINESIOTHERAPIST
• Pam Dennis, CCSS
• Robert A Desantis, MD
• Destination Life LLC-S (SaJourney)
• Don's Professional Drugs
• Melissa Kay Downing
• Linda Ducksworth

• General Practice Dentistry in Ellisville, MS
• Providers in Ellisville, 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 Mar 18, 2019; 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.