Provider Demographics
NPI:1447304324
Name:PIERCE, CAROLL D (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROLL
Middle Name:D
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DMD
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 380
Mailing Address - Street 2:503 MAIN STREET
Mailing Address - City:MT OLIVE
Mailing Address - State:MS
Mailing Address - Zip Code:39119
Mailing Address - Country:US
Mailing Address - Phone:601-797-3466
Mailing Address - Fax:601-797-3467
Practice Address - Street 1:503 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MT OLIVE
Practice Address - State:MS
Practice Address - Zip Code:39119
Practice Address - Country:US
Practice Address - Phone:601-797-3466
Practice Address - Fax:601-797-3467
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2097841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00060076Medicaid