Provider Demographics
NPI:1669523924
Name:JAMES D. NEAVES DDS PA
Entity type:Organization
Organization Name:JAMES D. NEAVES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NEAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-289-2771
Mailing Address - Street 1:207 N HUNTINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-3351
Mailing Address - Country:US
Mailing Address - Phone:662-289-2771
Mailing Address - Fax:662-289-2771
Practice Address - Street 1:207 N HUNTINGTON ST
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3351
Practice Address - Country:US
Practice Address - Phone:662-289-2771
Practice Address - Fax:662-289-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1465-711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00061903Medicaid