Healthcare Provider Details

I. General information

NPI: 1659464741
Provider Name (Legal Business Name): ALBERT JESSE SINGLETARY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/07/2023
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 Number2035 83
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2035-83
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: