Healthcare Provider Details

I. General information

NPI: 1194465781
Provider Name (Legal Business Name): ANNE MARIE CURRIE HREISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 FOUNTAINS DR
MADISON MS
39110-6384
US

IV. Provider business mailing address

312 FOUNTAINS DR
MADISON MS
39110-6384
US

V. Phone/Fax

Practice location:
  • Phone: 601-856-5313
  • Fax:
Mailing address:
  • Phone: 601-856-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4297-22
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4297-22
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: