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Contact Information

CANTON COMMUNITYDENTALCLINICLLC
512 W FULTON ST
CANTON, MS39046-4254
 Phone: 601-855-5885
 Fax: 601-855-2833
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for CANTON COMMUNITYDENTALCLINICLLC

NPI Number 1568567477
LBN Legal business name CANTON COMMUNITYDENTALCLINICLLC
Authorized official TIMOTHY JOHNSON - (DENTIST)
Entity Organization
Organization subpart 1 No
Enumeration date 09/14/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
MS License # 3108-99
MS Medicaid 08324092
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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