ELLISVILLE STATE SCHOOL DENTAL NPI 1013085414
Dentist in Ellisville, MS

About ELLISVILLE STATE SCHOOL DENTAL

Ellisville State School Dental is a provider established in Ellisville, Mississippi operating as a Dentist. The NPI number of Ellisville State School Dental is 1013085414 and was assigned on December 2006. The practitioner's primary taxonomy code is 122300000X with license number 09013809 (MS). The provider is registered as an organization and their NPI record was last updated 2 years ago. Ellisville State School Dental operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Suzie Lassiter (Director Of Facility)

NPI
1013085414
Provider NameELLISVILLE STATE SCHOOL DENTAL
Location Address1101 HIGHWAY 11 S ELLISVILLE, MS 39437
Location Phone(601) 477-9384
Mailing Address1101 HIGHWAY 11 S ELLISVILLE, MS 39437
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date12-01-2006
Last Update Date08-22-2020

A dentist like Ellisville State School Dental is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work..

The CLIA number of Ellisville State School Dental is 25D0030098 registered as a "intermediate care facility/individuals with intellectual disability" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Ellisville State School Dental to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.



Primary Taxonomy

The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Taxonomy Code122300000X
ClassificationDentist
TypeDental Providers
License No.09013809
License StateMS
Taxonomy DescriptionA 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.

Accepted Insurance

The NPI profile data indicates this provider might be enrolled and accepting insurance plans from the following companies or healthcare programs:

  • Medicaid
  • Medicare

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Business Address

ELLISVILLE STATE SCHOOL DENTAL
1101 HIGHWAY 11 S
ELLISVILLE, MS
ZIP 39437
Phone: (601) 477-9384
Fax: (601) 477-5700

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Mailing Address

ELLISVILLE STATE SCHOOL DENTAL
1101 HIGHWAY 11 S
ELLISVILLE, MS
ZIP 39437
Phone: (601) 477-9384
Fax: (601) 477-5700


Location Map

Authorized Official

The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

Authorized Official Name SUZIE LASSITER
Authorized Official TitleDIRECTOR OF FACILITY
Authorized Official Phone(601) 477-9384

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1013085414 is:

CLIA Number25D0030098
Facility TypeINTERMEDIATE CARE FACILITY/INDIVIDUALS WITH INTELLECTUAL DISABILITY
Certificate TypeCertificate of Waiver

Group Taxonomy


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

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
09013809MEDICAID (05)MS

NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1013085414
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2023081042
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 2 + 3 + 0 + 8 + 1 + 0 + 4 + 2 + 24 = 46
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 46 = 44

The NPI number 1013085414 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 11 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1225130040 PAUL IVAN HATHORN D.M.D.
Individual
Dentist1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-5792
1720181191ELLISVILLE STATE SCHOOL
Organization
Health Maintenance Organization1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-9384
1508962101MRS. LISA GRAHAM BLESSE FNP
Individual
Nurse Practitioner (Family)1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-5795
1164582821ELLISVILLE STATE SCHOOL
Organization
Technician1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-9384
1255364337DR. JOSEPH RODNEY MORING M.D.
Individual
Emergency Medicine1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-5772
1700125895 BREANNA L BONNER FNP
Individual
Nurse Practitioner (Family)1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-5771
1578668901ELLISVILLE STATE SCHOOL
Organization
Pharmacy (Long Term Care Pharmacy)1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-5785
1306914700HILLSIDE
Organization
Nursing Facility/Intermediate Care Facility1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-9384
1205904604PECAN GROVE
Organization
Nursing Facility/Intermediate Care Facility1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-9384
1598833998PAUL D. COTTEN
Organization
Nursing Facility/Intermediate Care Facility1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-9384
1992865653HOME COMMUNITY BASE WAIVER - ESS
Organization
Technician (Attendant Care Provider)1101 HIGHWAY 11 S
ELLISVILLE, MS 39437
(601) 477-9384

Frequently Asked Questions

What is ELLISVILLE STATE SCHOOL DENTAL NPI number?

The NPI number assigned to ELLISVILLE STATE SCHOOL DENTAL is 1013085414, registered as an "organization" on December 01, 2006

Where is ELLISVILLE STATE SCHOOL DENTAL located?

The provider is located at 1101 Highway 11 S Ellisville, Ms 39437 and the phone number is (601) 477-9384

What kind of medical provider is ELLISVILLE STATE SCHOOL DENTAL?

This medical organization specializes in Dentist

What insurance does ELLISVILLE STATE SCHOOL DENTAL accept?

The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your insurance plan is currently accepted.

What is ELLISVILLE STATE SCHOOL DENTAL CLIA number?

The provider's CLIA number is 25D0030098 for a "intermediate care facility/individuals with intellectual disability" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

How do I update my NPI information?

The NPI record of ELLISVILLE STATE SCHOOL DENTAL was last updated on December 01, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected]
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us at: [email protected]