DENTAL GROUP OF ELLISVILLE, PLLC (NPI# 1972851814) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972851814 |
| Entity Type | Organization |
| Organization Name | DENTAL GROUP OF ELLISVILLE, PLLC |
| Practice Address |
97 Hal Crocker Road Ellisville MS 39437 |
| Practice Telephone | 6014773779 |
| Practice Fax Number | 6014773770 |
| Mailing Telephone | 6014773779 |
| Mailing Fax Number | 6014773770 |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2019-03-18 |
| Authorized Official Name | TERRY LAKE GARNER (OWNER) |
| Authorized Official Telephone | 6012718710 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
2940-96 | MS | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00660377 | 05 |
| Street Address |
97 HAL CROCKER ROAD |
| City | ELLISVILLE |
| State | MS |
| Zip Code | 39437 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881227759 | Courtney J. Sims | Nurse Practitioner | 80 Hal Crocker Road, Ellisville, MS 39437 | 2020-02-19 |
| 1891228581 | Magnolia Gardens Assisted Living | Assisted Living Facility | 303 East Ivy, Ellisville, MS 39437 | 2017-04-10 |
| 1891920518 | Amy E Young | Speech-Language Pathologist | 471 Hwy 590, Ellisville, MS 39437 | 2009-05-26 |
| 1053486852 | Natalia Angelia Stevenson | Nurse Practitioner | Ellisville State School, 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-11-21 |
| 1831275189 | Womens Pavilion of South Mississippi, Pllc | Obstetrics & Gynecology | 1242 Hwy 29 North, Ellisville, MS 39437 | 2006-10-30 |
| 1861578635 | Jennifer Reeder Mascagni | Nurse Practitioner | 1203 Ave B Ste 200, Ellisville, MS 39437 | 2006-10-27 |
| 1851499982 | Kathleen Frances Mccoy | Physical Therapist | 1101 Hwy 11 South, Ellisville, MS 39437 | 2006-09-20 |
| 1861498610 | Patricia A. Tibbs | Pediatrics | 1203 Avenue B, Ellisville, MS 39437 | 2005-06-27 |
| 1700954765 | Shelia Dianne Bradford | Nurse Practitioner | 1203 Avenue B, Ellisville, MS 39437 | 2006-11-30 |
| 1316980097 | Donald Scoggin | Nurse Practitioner | 1203 Ave B, Ellisville, MS 39437 | 2006-06-13 |
| Find all providers in zip 39437 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013386598 | 16111 Manchester Road, L.L.C. | Dentist | 428 Old State Rd., Ellisville, MO 63021 | 2015-09-15 |
| 1114289394 | Alecia A Moore | Dentist | 97 Hal Crocker Rd, Ellisville, MS 39437-2088 | 2012-06-13 |
| 1578694709 | Bernard David Wilken | Dentist | 265 Clarkson Rd, Ellisville, MO 63011-2219 | 2007-03-08 |
| 1346399953 | Stephen L Surber | Dentist | 401 Highway 11 S, Ellisville, MS 39437-3103 | 2007-01-10 |
| 1760549380 | Michael P Frith Dds | Dentist | 269 Clarkson Rd, Ellisville, MO 63011-2219 | 2007-01-02 |
| 1518028703 | Andrew G. Mitchell, Inc. | Dentist | 15991 Manchester Rd, Ellisville, MO 63011-2140 | 2006-12-12 |
| 1639244700 | Frederick Alan Karwas | Dentist | 184 Clarkson Rd, Ellisville, MO 63011-2244 | 2006-11-22 |
| 1184720252 | Gilbert R. Hart | Dentist | 428 Old State Rd, Ellisville, MO 63021-5918 | 2006-09-16 |
| 1396758793 | Crystal Martin | Dentist | 277 Clarkson Rd, Ste 100, Ellisville, MO 63011 | 2006-08-15 |
| 1992235899 | Megan Michelle Wolf | Dentist | 12 Hutchinson Rd, Ellisville, MO 63011-5702 | 2017-06-14 |
| Find all providers in ELLISVILLE | ||||
| City | ELLISVILLE |
| Zip Code | 39437 |
Please comment or provide details below to improve the information on DENTAL GROUP OF ELLISVILLE, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.