Healthcare Provider Details

I. General information

NPI: 1467554378
Provider Name (Legal Business Name): ALBERT J. SINGLETARY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 WEST GEORGETOWN ST.
CRYSTAL SPRINGS MS
39059
US

IV. Provider business mailing address

707 WEST GEORGETOWN ST.
CRYSTAL SPRINGS MS
39059
US

V. Phone/Fax

Practice location:
  • Phone: 601-892-3444
  • Fax: 601-892-4778
Mailing address:
  • Phone: 601-892-3444
  • Fax: 601-892-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number203583
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2035-83
License Number StateMS

VIII. Authorized Official

Name: DR. ALBERT JESSE SINGLETARY
Title or Position: PRESIDENT
Credential: DMD
Phone: 601-892-3444