Healthcare Provider Details

I. General information

NPI: 1215862537
Provider Name (Legal Business Name): JOSIE PACE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17215 MS-26
LUCEDALE MS
39452
US

IV. Provider business mailing address

8201 OLD 63 S
LUCEDALE MS
39452-4956
US

V. Phone/Fax

Practice location:
  • Phone: 601-947-4828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112659
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: