Healthcare Provider Details

I. General information

NPI: 1134180557
Provider Name (Legal Business Name): JIMMY F VESSELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 MISSION 66
VICKSBURG MS
39183-2753
US

IV. Provider business mailing address

1011 MISSION 66
VICKSBURG MS
39183-2753
US

V. Phone/Fax

Practice location:
  • Phone: 601-636-6081
  • Fax: 601-638-5482
Mailing address:
  • Phone: 601-636-6081
  • Fax: 601-638-5482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number930-59
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: