Healthcare Provider Details

I. General information

NPI: 1467341560
Provider Name (Legal Business Name): CHRISTTSON CESAR MENDES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

875 WILLIAM BLVD APT 1010
RIDGELAND MS
39157-1524
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6185
  • Fax:
Mailing address:
  • Phone: 407-556-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number000000
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: