| Children's Dental Clinic, Pa | |
|
1555 Medical Park Cir Tupelo MS 38801-6580 | |
| (662) 844-3315 | |
| (662) 842-8228 |
| Full Name | Children's Dental Clinic, Pa |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1555 Medical Park Cir, Tupelo, Mississippi |
| Authorized Official Name and Position | Trice W Sumner (PRESIDENT) |
| Authorized Official Contact | 6628443315 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Children's Dental Clinic, Pa 1555 Medical Park Cir Tupelo MS 38801-6580 Ph: (662) 844-3315 | Children's Dental Clinic, Pa 1555 Medical Park Cir Tupelo MS 38801-6580 Ph: (662) 844-3315 |
| NPI Number | 1619579349 |
|---|---|
| Provider Enumeration Date | 11/09/2020 |
| Last Update Date | 11/09/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619579349 | NPI | - | NPPES |
| 00660366 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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