Healthcare Provider Details

I. General information

NPI: 1740385202
Provider Name (Legal Business Name): BRIAN DARREL RHOADS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 FOUNTAIN LN
HORN LAKE MS
38637-1384
US

IV. Provider business mailing address

4033 FOUNTAIN LN
HORN LAKE MS
38637-1384
US

V. Phone/Fax

Practice location:
  • Phone: 662-427-3386
  • Fax:
Mailing address:
  • Phone: 662-427-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111697
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: