Provider Demographics
NPI:1104927243
Name:PRECHEUR, HARRY VINCENT (DMD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:VINCENT
Last Name:PRECHEUR
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 1:2500 N. STATE ST.
Mailing Address - Street 2:SCHOOL OF DENTISTRY
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-984-6090
Mailing Address - Fax:601-984-4949
Practice Address - Street 1:2500 N. STATE ST.
Practice Address - Street 2:SCHOOL OF DENTISTRY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-6090
Practice Address - Fax:601-984-4949
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3282-03122300000X
MSOS372-031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03637857Medicaid
MS03637857Medicaid