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General NPI Number Information
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NPI Number | 1255483186
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Entity Type | Organization
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Legal Business Name | PICAYUNE GENERAL DENTISTRY, INC.
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 GOODYEAR BLVD
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City | PICAYUNE
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State | MS
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Zip | 39466-3217
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Country | US
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Telephone | 601-798-0500
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Fax | 601-799-0141
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Provider Business Mailing Address
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Address Line | 500 GOODYEAR BLVD
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City | PICAYUNE
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State | MS
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Zip | 39466-3217
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Country | US
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Telephone | 601-798-0500
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Fax | 601-799-0141
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. HORACE EUGENE COMBS III
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Credential | D.M.D.
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Telephone | 601-798-0500
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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 | 3213-02
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License Number State | MS
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