| Kellum Dental Clinic | |
|
505 Robins St Tupelo MS 38804-3715 | |
| (662) 842-5080 | |
| (662) 842-5896 |
| Full Name | Kellum Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 505 Robins St, Tupelo, Mississippi |
| Authorized Official Name and Position | Shaundi B. Little (OFFICE MANAGER) |
| Authorized Official Contact | 6628425080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kellum Dental Clinic Po Box 1486 Tupelo MS 38802-1486 Ph: (662) 842-5080 | Kellum Dental Clinic 505 Robins St Tupelo MS 38804-3715 Ph: (662) 842-5080 |
| NPI Number | 1528280880 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528280880 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 1782-77 (Mississippi) | Primary |
| 261QD0000X | Clinic/center - Dental | 2554-90 (Mississippi) | Secondary |
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