Back Bay Family Dentistry

LBN: Back Bay Family Dentistry
Back Bay Family Dentistry is an health care organization with primary practice located at 10409 Boney Ave , Diberville MS 39540-4813. The organization recently has only one registered license in Dental Providers / General Practice, which is considered as the primary health care specialty. Back Bay Family Dentistry can be contacted via phone (228) 392-0509, or through Parker, Jeremy W via phone (228) 392-0509.

Contact Information

Primary practice address
10409 Boney Ave Diberville MS 39540-4813
Phone: (228) 392-0509
Fax: (228) 392-8709
Website:
Map and Directions
Authorized official contact:
Name: Parker, Jeremy W Doctor of Dental Medicine (DMD)
Phone: (228) 392-0509

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 3553-10 Mississippi

Profile Details

NPI number 1316306988
LBN Legal business name Back Bay Family Dentistry
DBA Doing business as
Authorized official Parker, Jeremy W Doctor of Dental Medicine (DMD)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 11th, 2016
Last updated Feb 11th, 2016 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316306988 NPPES
Mississippi MEDICAID 09424204

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