Healthcare Provider Details

I. General information

NPI: 1104933316
Provider Name (Legal Business Name): JAMES M HUONI SR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 NO BROAD STREET
LELAND MS
38756
US

IV. Provider business mailing address

305 NO BROAD STREET
LELAND MS
38756
US

V. Phone/Fax

Practice location:
  • Phone: 662-686-2009
  • Fax:
Mailing address:
  • Phone: 662-686-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1891 80
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: