Healthcare Provider Details

I. General information

NPI: 1487476859
Provider Name (Legal Business Name): SOUTH MISSISSIPPI DENTAL SLEEP MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 S MAIN ST
POPLARVILLE MS
39470-4287
US

IV. Provider business mailing address

1718 S MAIN ST
POPLARVILLE MS
39470-4287
US

V. Phone/Fax

Practice location:
  • Phone: 601-795-8024
  • Fax: 601-795-0745
Mailing address:
  • Phone: 601-795-8024
  • Fax: 601-795-0745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON ESTEP
Title or Position: DOCTOR/OWNER
Credential: D.M.D.
Phone: 601-795-8024