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General NPI Number Information
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NPI Number | 1720142219
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Entity Type | Organization
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Legal Business Name | BOUNDS FAMILY DENTAL
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 1010 N 15TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-2656
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Country | US
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Telephone | 601-649-3511
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 N 15TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-2656
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Country | US
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Telephone | 601-649-3511
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES A BOUNDS
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Credential | D.M.D
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Telephone | 601-649-3511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 200483
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License Number State | MS
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