Healthcare Provider Details

I. General information

NPI: 1831377134
Provider Name (Legal Business Name): GREGGORY E. THARP DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2695 FLOWOOD DRIVE
FLOWOOD MS
39232
US

IV. Provider business mailing address

2695 FLOWOOD DRIVE
FLOWOOD MS
39232
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-4100
  • Fax: 601-939-4081
Mailing address:
  • Phone: 601-939-4100
  • Fax: 601-939-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number331104
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KIM H. DAVIS
Title or Position: MEDICAL BILLER
Credential:
Phone: 601-939-4100