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ELLISVILLE STATE SCHOOL DENTAL
NPI 1013085414
Dentist in Ellisville, MS

Active since December 01, 2006CLIA 25D0030098 · Waiver
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437(601) 477-9384(601) 477-5700 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Ellisville State School Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELLISVILLE STATE SCHOOL DENTAL (NPI 1013085414) is a healthcare organization registered as a dentist in Ellisville, Mississippi and active in the NPI registry since December 2006. The organization holds a CLIA Waiver certificate valid through May 6, 2028 and lists Suzie Lassiter, Director Of Facility, as its authorized official.

NPPES Registry Identity

NPI1013085414
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameELLISVILLE STATE SCHOOL DENTAL
Location Address1101 HIGHWAY 11 SEllisville, MS 39437-4443
Mailing Address1101 Highway 11 SEllisville, MS 39437-4443 · (601) 477-9384 · Fax (601) 477-5700
Phone(601) 477-9384
Fax(601) 477-5700
Organization SubpartNo
Authorized OfficialSuzie LassiterDirector Of Facility · (601) 477-9384
Enumeration DateDecember 1, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1013085414 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in MS · 09013809
Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

1101 HIGHWAY 11 S, Ellisville, MS 39437
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Other Identifiers 1

Medicaid09013809MS

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D0030098

Ellisville State School · Ellisville, MS
Active · expires May 6, 2028
CLIA Number25D0030098
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateMay 7, 2026
Certificate Expiration DateMay 6, 2028
Laboratory DirectorDr. Joseph Moring
Laboratory Phone(601) 477-9384
Laboratory LocationEllisville State School1101 Highway 11 South, Ellisville, MS 39437
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELLISVILLE STATE SCHOOL
Technician
1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
Jones County (601) 477-9384
PECAN GROVE
Nursing Facility/Intermediate Care Facility
1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
Jones County (601) 477-9384
PAUL IVAN HATHORN D.M.D.
Dentist
1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
Jones County (601) 477-5792
DR. JOSEPH RODNEY MORING M.D.
Emergency Medicine
1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
Jones County (601) 477-5772
HILLSIDE
Nursing Facility/Intermediate Care Facility
1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
Jones County (601) 477-9384
MRS. LISA GRAHAM BLESSE FNP
Nurse Practitioner (Family)
1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
Jones County (601) 477-5795
ELLISVILLE STATE SCHOOL
Pharmacy (Long Term Care Pharmacy)
1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
Jones County (601) 477-5785
PAUL D. COTTEN
Nursing Facility/Intermediate Care Facility
1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
Jones County (601) 477-9384

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ellisville State School Dental's NPI number?

The NPI number for Ellisville State School Dental is 1013085414. It was assigned to this organization in the NPPES registry on December 1, 2006.

Where is Ellisville State School Dental located?

Ellisville State School Dental is located at 1101 Highway 11 S, Ellisville, MS 39437. The listed phone number is (601) 477-9384.

What is Ellisville State School Dental's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Does Ellisville State School Dental hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D0030098) is associated with this NPI, valid through May 6, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ellisville State School Dental was last updated on August 22, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.