Healthcare Provider Details

I. General information

NPI: 1811075245
Provider Name (Legal Business Name): DONALD E PRICE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LAUREL STREET
SUMMIT MS
39666
US

IV. Provider business mailing address

PO BOX 789
SUMMIT MS
39666-0789
US

V. Phone/Fax

Practice location:
  • Phone: 601-276-7915
  • Fax: 601-276-7929
Mailing address:
  • Phone: 601-276-7915
  • Fax: 601-276-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1766-77
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: