CENTER AVENUE DENTAL CARE, LLC (NPI# 1710127311) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710127311 |
| Entity Type | Organization |
| Organization Name | CENTER AVENUE DENTAL CARE, LLC |
| Practice Address |
90 Center Ave Sumrall MS 39482-5002 |
| Mailing Address |
90 Center Ave P.o. Box 217 Sumrall MS 39482-5002 |
| Practice Telephone | 6017583535 |
| Practice Fax Number | 6017589225 |
| Mailing Telephone | 6017583535 |
| Mailing Fax Number | 6017589225 |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2009-02-23 |
| Authorized Official Name | DR. ROGER KYLE BASS (PRESIDENT) |
| Authorized Official Telephone | 6017654355 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | BISHOP & BASS, P.A. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
3287 | MS | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 02880272 | 05 | |
| MS | 01751273 | 05 |
| Street Address |
90 CENTER AVE |
| City | SUMRALL |
| State | MS |
| Zip Code | 39482-5002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396158390 | Sherry Nichole Racey | Dentist | 90 Center Ave, Sumrall, MS 39482-5002 | 2014-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891255295 | Southern Saferide Transportation | Non-emergency Medical Transport (VAN) | 309 Hr Watts Road, Sumrall, MS 39482 | 2019-03-21 |
| 1346598380 | Serene Adult Care | Technician | 261 H.r. Watts Rd, Sumrall, MS 39482 | 2012-08-23 |
| 1346472628 | Patsy K Mcgrew | Counselor | 14 Ravenwood Lane, Sumrall, MS 39482 | 2009-08-20 |
| 1952572919 | Brett Alan Valentine D.m.d. | Dentist | 4864-b Hwy 589, Sumrall, MS 39482 | 2008-03-18 |
| 1205924834 | Medical Plus, LLC | Durable Medical Equipment & Medical Supplies | 4 Preston St, Sumrall, MS 39482 | 2006-10-10 |
| 1396844734 | Brett A Valentine | Dentist | 4864 B Hwy 589, Sumrall, MS 39482 | 2006-09-22 |
| 1881703429 | Kimberly R Schramm | Physical Therapist | 1240 Highway 42, Sumrall, MS 39482 | 2006-08-29 |
| 1942217757 | John David Bullock | Family Medicine | 1238 Highway 42, Sumrall, MS 39482 | 2006-08-02 |
| 1871128934 | Brandon Scott Nesler | Pharmacist | 1109 Hwy 42, Sumrall, MS 39482 | 2020-03-10 |
| 1366004731 | Sumrall Drug Store LLC | Pharmacy | 1109 Hwy 42, Sumrall, MS 39482 | 2019-07-05 |
| Find all providers in zip 39482 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952572919 | Brett Alan Valentine D.m.d. | Dentist | 4864-b Hwy 589, Sumrall, MS 39482 | 2008-03-18 |
| 1396844734 | Brett A Valentine | Dentist | 4864 B Hwy 589, Sumrall, MS 39482 | 2006-09-22 |
| 1396158390 | Sherry Nichole Racey | Dentist | 90 Center Ave, Sumrall, MS 39482-5002 | 2014-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932706306 | Brenyatta Travis | Dentist | 28 Pass Rd Ste 300, Gulfport, MS 39507-3244 | 2020-10-07 |
| 1518564210 | Reagan Mcnerney | Dentist | 275 11th Ave Sw, Magee, MS 39111-3553 | 2020-10-06 |
| 1841817657 | Kimberly Nicole Lee | Dentist | 105 Broadmoor Dr, Madison, MS 39110-6651 | 2020-06-26 |
| 1255955340 | Terah Shelby | Dentist | 2139 Highway 471, Brandon, MS 39047-8748 | 2020-06-03 |
| 1275157463 | Anderson Reid Bensch | Dentist | 160 Cracker Barrell Dr, Batesville, MS 38606-3031 | 2020-06-03 |
| 1831713213 | Scarlett La'ree Johnson | Dentist | 155 Millhouse Dr, Madison, MS 39110-6964 | 2020-06-02 |
| 1649893363 | Prestige Dental Care | Dentist | 7138 S Siwell Road, Byram, MS 39272 | 2020-05-28 |
| 1831746338 | Gary Williams LLC | Dentist | 100 Marketplace Dr Ste B, Byram, MS 39272-8974 | 2019-08-20 |
| 1518528769 | Huey D Phillips Jr. | Dentist | 5204 Highway 51 N, Senatobia, MS 38668-1712 | 2019-06-27 |
| 1649839291 | Andrew Harris | Dentist | 4505 I-55 Frontage Rd. N, Jackson, MS 39206 | 2019-06-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.