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Contact Information

ELLISVILLE FAMILY DENTAL CENTER PA
401 HIGHWAY 11 S
ELLISVILLE, MS39437-3103
 Phone: 601-477-3771
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for ELLISVILLE FAMILY DENTAL CENTER PA

NPI Number 1033269840
LBN Legal business name ELLISVILLE FAMILY DENTAL CENTER PA
Authorized official STEPHEN SURBER - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/12/2007
Last updated 08/31/2016 - About 10 years ago
Identifiers
MS License # 2366-87
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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