Provider Demographics
NPI:1972365500
Name:HIGHFIVE ENDODONTICS MISSISSIPPI, PLLC
Entity type:Organization
Organization Name:HIGHFIVE ENDODONTICS MISSISSIPPI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:PRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-856-6364
Mailing Address - Street 1:301 NORTHLAKE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1720
Mailing Address - Country:US
Mailing Address - Phone:601-856-6364
Mailing Address - Fax:601-856-7545
Practice Address - Street 1:301 NORTHLAKE AVE STE 111
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1720
Practice Address - Country:US
Practice Address - Phone:601-856-6364
Practice Address - Fax:601-856-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty