Provider Demographics
NPI:1831264035
Name:DOCKINS DENTAL LLC
Entity type:Organization
Organization Name:DOCKINS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANDREA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOCKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-982-0048
Mailing Address - Street 1:500I E WOODROW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4538
Mailing Address - Country:US
Mailing Address - Phone:601-982-0048
Mailing Address - Fax:601-982-0388
Practice Address - Street 1:500I EAST WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-982-0048
Practice Address - Fax:601-982-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07134218Medicaid