LEAF RIVER DENTAL, PLLC
NPI 1750906707
Clinic/Center - Dental in Petal, MS
Active since June 15, 2020
About Leaf River Dental, Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LEAF RIVER DENTAL, PLLC (NPI 1750906707) is a healthcare organization registered as a dental in Petal, Mississippi and active in the NPI registry since June 2020. The organization lists Lanthea Mangum, Coo, as its authorized official.
NPPES Registry Identity
NPI1750906707
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameLEAF RIVER DENTAL, PLLC
Location Address1115 EVELYN GANDY PARKWAYPetal, MS 39465
Mailing Address4358 Lincoln Road Ext Ste 20Hattiesburg, MS 39402-3275 · (601) 271-8710
Phone(601) 271-8710
Organization SubpartNo
Authorized OfficialLanthea MangumCoo · (601) 271-8710
Enumeration DateJune 15, 2020
NPPES CertifiedJune 15, 2020
✔ NPI 1750906707 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
1115 EVELYN GANDY PARKWAY, Petal, MS 39465
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Dentist (General Practice)
1115 EVELYN GANDY PARKWAY
PETAL, MS 39465
PETAL, MS 39465
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1750906707, enumerated as an "organization" on June 15, 2020.
The provider is located at 1115 EVELYN GANDY PARKWAY PETAL, MS 39465 and the phone number is (601) 271-8710.
Clinic/Center with taxonomy code 261QD0000X and a focus in Dental.
