Healthcare Provider Details

I. General information

NPI: 1104927243
Provider Name (Legal Business Name): HARRY VINCENT PRECHEUR D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N. STATE ST. SCHOOL OF DENTISTRY
JACKSON MS
39216
US

IV. Provider business mailing address

2500 N. STATE ST. SCHOOL OF DENTISTRY
JACKSON MS
39216
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6090
  • Fax: 601-984-4949
Mailing address:
  • Phone: 601-984-6090
  • Fax: 601-984-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3282-03
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberOS372-03
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: