Petal Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PETAL FAMILY DENTISTRY

Practice address

139 S Main St
Petal, MS 39465-2331

Phone

(601) 584-9481

Fax

(601) 544-5161

NPI assigned

Oct 23, 2014

Last updated

Oct 23, 2014By 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

Dr. Charles J Harrell Jr., D.M.D.NPI 1093803231

Title

Partner/Dentist

Phone

(601) 584-9481

Specialties & licenses 1

Addresses

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.

• Charles J. Harrell Jr., D.M.D.

  • General Practice Dentistry
  • Petal, MS
  • NPI 1093803231
  NPD (past) Authorized official
• Bobby Glenn Braswell Jr., DDS

  • General Practice Dentistry
  • Petal, MS
  • NPI 1295949386
  NPD (past)

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414022400000",
    "number": "1972908622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 S MAIN ST",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394652331",
            "telephone_number": "601-584-9481",
            "fax_number": "601-544-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 S MAIN ST",
            "city": "PETAL",
            "state": "MS",
            "postal_code": "394652331",
            "telephone_number": "601-584-9481",
            "fax_number": "601-544-5161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETAL FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-23",
        "last_updated": "2014-10-23",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PARTNER/DENTIST",
        "authorized_official_telephone_number": "601-584-9481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph J Patterson, DPT
• Robert Perez
• Petal Chiropractic Clinic, Inc.
• Petal Dental Properties (Pediatric Dental Group of Petal)
• Petal Drug Company, Inc.
• Petal Middle School
• Petal Primary School
• Petal School Clinic
• Petal School District
• Petal School District

• General Practice Dentistry in Petal, MS
• Providers in Petal, 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 Oct 23, 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.