MS PERIODONTIC SPECIALISTS GROUP, PLLC (NPI# 1851640437) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851640437 |
| Entity Type | Organization |
| Organization Name | MS PERIODONTIC SPECIALISTS GROUP, PLLC |
| Practice Address |
209 Woodline Dr. Flowood MS 39232 |
| Practice Telephone | 6016642600 |
| Practice Fax Number | 6016642650 |
| Mailing Telephone | 6016642600 |
| Mailing Fax Number | 6016642650 |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2014-08-12 |
| Authorized Official Name | DR. SAMUEL REID LESTER (OWNER) |
| Authorized Official Telephone | 6016642600 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
45012 | MS | Dental Providers |
| Street Address |
209 WOODLINE DR. |
| City | FLOWOOD |
| State | MS |
| Zip Code | 39232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164071775 | Leanna Nicole Howard | Social Worker | 2945 Layfair Drive, Apt. 1621, Flowood, MS 39232 | 2019-09-06 |
| 1104395565 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 4800 Lakeland Drive, Flowood, MS 39232 | 2018-11-15 |
| 1285101816 | Magnolia Anesthesia Consultants LLC | Anesthesiology | 4209 Lakeland Dr #252, Flowood, MS 39232 | 2018-11-01 |
| 1528543592 | Matthew T Armstrong | Physical Therapist | 104 Burney Drive, Flowood, MS 39232 | 2018-09-26 |
| 1790265627 | Mississippi Brain and Spine, Pllc | Non-Pharmacy Dispensing Site | 1 Layfair Drive, Ste 120, Flowood, MS 39232 | 2018-08-20 |
| 1629574918 | Billy Clifton Osbon Jr. | Pharmacist | 2506 Lakeland Drive, Suite 201, Flowood, MS 39232 | 2018-04-04 |
| 1356851752 | Oakdale Family Dentistry | Clinic/Center | 2139 Hwy 471, Flowood, MS 39232 | 2017-10-11 |
| 1992227177 | Charisma T. Cummings | Nurse Practitioner | 102 Riverview Drive, Suite A, Flowood, MS 39232 | 2017-07-10 |
| 1508398983 | Charles Pearson | Student in an Organized Health Care Education/Training Program | 764 Flowood Dr, Flowood, MS 39232 | 2017-04-03 |
| 1396288197 | Mary Claire Ponder | Nurse Practitioner | 151 E Metro Dr Ste 103, Flowood, MS 39232 | 2016-11-28 |
| Find all providers in zip 39232 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497112825 | Mississippi Periodontics and Implants Pllc | Dentist | 218 West Jackson Street, Ridgeland, MS 39157 | 2016-01-15 |
| 1932531373 | North Mississippi Periodontics & Implant Dentistry Pllc | Dentist | 103 Park Gate Ext, Tupelo, MS 38801-3038 | 2013-08-08 |
| 1790069854 | Periodontal Associates of Jackson, P.a. | Dentist | 406 Briarwood Dr., Ste. 101, Jackson, MS 39206 | 2011-10-06 |
| 1992997159 | Rodney C Richardson | Dentist | 1609 24th Ave, Meridian, MS 39301-3112 | 2007-08-13 |
| 1699966770 | Brenda Lyle Fowler | Dentist | 2408 S Lamar Blvd, Suite 3, Oxford, MS 38655-5345 | 2007-08-05 |
| 1730385139 | Bernard Frederick Podlin | Dentist | 400 Pass Road, Gulfport, MS 39507 | 2007-06-22 |
| 1417166703 | R. Clarke Stewart | Dentist | 406 Briarwood Dr Ste 101, Jackson, MS 39206-3059 | 2007-05-22 |
| 1750594412 | James Michael Robertson | Dentist | 103 Parkgate Drive Extended, Tupelo, MS 38801-3038 | 2007-05-08 |
| 1134341407 | Nichols Periodontics LLC | Dentist | 2401 5th Street North, Suite 2, Columbus, MS 39705 | 2007-05-03 |
| 1689719486 | Charles Joseph Caskey | Dentist | 218 West Jackson St., Ridgeland, MS 39157 | 2007-02-20 |
| 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.