Provider Demographics
NPI:1548269673
Name:TURNER, JERRY DWIGHT (D D S)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:DWIGHT
Last Name:TURNER
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-0266
Mailing Address - Country:US
Mailing Address - Phone:662-323-9794
Mailing Address - Fax:
Practice Address - Street 1:303 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2155
Practice Address - Country:US
Practice Address - Phone:662-323-1339
Practice Address - Fax:662-324-0554
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1495-72122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL730-12563OtherBCBS OF AL
MS26842OtherUNITED CONCORDIA
MS00062808Medicaid