Healthcare Provider Details

I. General information

NPI: 1316151475
Provider Name (Legal Business Name): JASON SCOTT RECTOR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 GOVERNMENT ST
OCEAN SPRINGS MS
39564-4011
US

IV. Provider business mailing address

2323 GOVERNMENT ST
OCEAN SPRINGS MS
39564-4011
US

V. Phone/Fax

Practice location:
  • Phone: 228-369-4639
  • Fax: 228-436-4333
Mailing address:
  • Phone: 228-369-4639
  • Fax: 228-436-4333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3102-99
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberPEDO-369-03
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3102-99
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: