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CHOCTAW HEALTH CENTER DENTAL
NPI 1073715579
Dentist in Choctaw, MS

Active since June 05, 2007CLIA 25D2092846 · Waiver
210 HOSPITAL CIR, CHOCTAW, MS 39350(601) 389-6342(601) 663-7721 Get Directions Write a Review

NPPES record last updated: June 15, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Choctaw Health Center Dental NPPES

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

CHOCTAW HEALTH CENTER DENTAL (NPI 1073715579) is a healthcare organization registered as a dentist in Choctaw, Mississippi and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through March 15, 2027 and lists Phyllis J Anderson, Tribal Chief, as its authorized official.

NPPES Registry Identity

NPI1073715579
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameMISSISSIPPI BAND OF CHOCTAW INDIANS
Location Address210 HOSPITAL CIRChoctaw, MS 39350-6781
Mailing Address210 Hospital CirChoctaw, MS 39350-6781 · (601) 389-6342 · Fax (601) 663-7721
Phone(601) 389-6342
Fax(601) 663-7721
Organization SubpartYes
Authorized OfficialPhyllis J AndersonTribal Chief · (601) 656-5251
Enumeration DateJune 5, 2007
Last NPPES UpdateJune 15, 2012
✔ NPI 1073715579 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
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.
210 HOSPITAL CIR, Choctaw, MS 39350
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Other Names 1

Doing Business AsChoctaw Health Center Dental

Other Identifiers 2

Other000010359MS · Bc Bs Dental Provider Num
Medicaid9013488MS

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-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 25D2092846

Choctaw Health Center Dental Department · Choctaw, MS
Active · expires Mar 15, 2027
CLIA Number25D2092846
Laboratory TypeDental
Certificate Effective DateMarch 16, 2025
Certificate Expiration DateMarch 15, 2027
Laboratory DirectorBrian C. Berg
Laboratory Phone(601) 389-4030
Laboratory LocationChoctaw Health Center Dental DepartmentAttn Brian Berg Dmd 210 Hospital Circle, Choctaw, MS 39350
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

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

MR. EDDIE D RUTHERFORD RPH
Pharmacist
210 HOSPITAL CIR
CHOCTAW, MS 39350
Neshoba County (601) 389-4330
LINDA MURRAY FNP
Nurse Practitioner
210 HOSPITAL CIR
CHOCTAW, MS 39350
Neshoba County (601) 656-2211
JESSICA NICHOLE BLACK
Registered Nurse (Psychiatric/Mental Health)
210 HOSPITAL CIR
CHOCTAW, MS 39350
Neshoba County (601) 389-4150
MS BAND OF CHOCTAW INDIANS
Case Manager/Care Coordinator
210 HOSPITAL CIR
CHOCTAW, MS 39350
Neshoba County (601) 656-2211
DR. STEVEN KORY CULPEPPER PHARM.D.
Pharmacist
210 HOSPITAL CIR
CHOCTAW, MS 39350
Neshoba County (601) 389-4300
MRS. PENNY WEST DICKERSON RD
Dietitian, Registered
210 HOSPITAL CIR
CHOCTAW, MS 39350
Neshoba County (601) 389-4132
JESSICA W MOONEY PHARMACIST
Pharmacist
210 HOSPITAL CIR
CHOCTAW, MS 39350
Neshoba County (601) 656-2211
DAPHNE ROCHELLE HOLMES
Social Worker (Clinical)
210 HOSPITAL CIR
CHOCTAW, MS 39350
Neshoba County (601) 389-4166

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 Mississippi Band Of Choctaw Indians's NPI number?

The NPI number for Mississippi Band Of Choctaw Indians is 1073715579. It was assigned to this organization in the NPPES registry on June 5, 2007. The provider is doing business as Choctaw Health Center Dental.

Where is Mississippi Band Of Choctaw Indians located?

Mississippi Band Of Choctaw Indians is located at 210 Hospital Cir, Choctaw, MS 39350. The listed phone number is (601) 389-6342.

What is Mississippi Band Of Choctaw Indians's specialty?

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

Does Mississippi Band Of Choctaw Indians hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2092846) is associated with this NPI, valid through March 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mississippi Band Of Choctaw Indians was last updated on June 15, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.