Healthcare Provider Details

I. General information

NPI: 1821391202
Provider Name (Legal Business Name): CENTRAL MISSISSIPPI ORAL & MAXIOLLOFACIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 952
JACKSON MS
39216-4609
US

IV. Provider business mailing address

971 LAKELAND DR STE 952
JACKSON MS
39216-4609
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-3111
  • Fax: 601-981-3112
Mailing address:
  • Phone: 601-981-3111
  • Fax: 601-981-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1521
License Number StateMS

VIII. Authorized Official

Name: DR. RODNEY A HUNT
Title or Position: DR.
Credential: D.D.S
Phone: 601-981-3111