Provider Demographics
NPI:1861696114
Name:DAVID FUTRELL
Entity type:Organization
Organization Name:DAVID FUTRELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FUTRELL
Authorized Official - Last Name:EDWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-798-4221
Mailing Address - Street 1:814 HWY 43 NORTH
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466
Mailing Address - Country:US
Mailing Address - Phone:601-798-4221
Mailing Address - Fax:601-798-4221
Practice Address - Street 1:814 HIGHWAY 43 N
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2233
Practice Address - Country:US
Practice Address - Phone:601-798-4221
Practice Address - Fax:601-798-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty