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General NPI Number Information
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NPI Number | 1104957422
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Entity Type | Organization
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Legal Business Name | HILLCREST DENTAL GROUP, P.A.
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 382 COURTHOUSE RD STE B
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City | GULFPORT
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State | MS
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Zip | 39507-1864
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Country | US
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Telephone | 228-604-2445
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Fax | 228-604-2525
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Provider Business Mailing Address
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Address Line | 382 COURTHOUSE RD STE B
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City | GULFPORT
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State | MS
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Zip | 39507-1864
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Country | US
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Telephone | 228-604-2445
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Fax | 228-604-2525
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Authorized Official
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Title or Position | DENTIST / PRESIDENT
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Name | DR. THERESA G JONES
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Credential | D.M.D.
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Telephone | 228-604-2445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 202283
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License Number State | MS
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