Healthcare Provider Details

I. General information

NPI: 1144508664
Provider Name (Legal Business Name): JAMES PATRICK NALL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

301 FISHER ST ORAL SURGERY DEPT
KEESLER AFB MS
39534-2508
US

V. Phone/Fax

Practice location:
  • Phone: 228-376-0610
  • Fax:
Mailing address:
  • Phone: 228-376-0610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number9089
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: