| Westside Dental, Pllc | |
|
3694 W Jackson St Tupelo MS 38801 | |
| (662) 842-8035 | |
| (662) 842-3018 |
| Full Name | Westside Dental, Pllc |
|---|---|
| Speciality | Dentist |
| Location | 3694 W Jackson St, Tupelo, Mississippi |
| Authorized Official Name and Position | Kenneth Lee Austin (MANAGER) |
| Authorized Official Contact | 6628428035 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Westside Dental, Pllc 3694 W Jackson St Tupelo MS 38801 Ph: (662) 842-8035 | Westside Dental, Pllc 3694 W Jackson St Tupelo MS 38801 Ph: (662) 842-8035 |
| NPI Number | 1669596318 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 06/23/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669596318 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 303298 (Mississippi) | Primary |
| 122300000X | Dentist | 298897 (Mississippi) | Secondary |
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