| Pediatric Dentistry, P.a. | |
|
5315 Highway 18 W Jackson MS 39209-9421 | |
| (601) 922-0066 | |
| (601) 922-0077 |
| Full Name | Pediatric Dentistry, P.a. |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5315 Highway 18 W, Jackson, Mississippi |
| Authorized Official Name and Position | L Lee Cope (DENTIST) |
| Authorized Official Contact | 6019220066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry, P.a. 5315 Highway 18 W Jackson MS 39209-9421 Ph: (601) 922-0066 | Pediatric Dentistry, P.a. 5315 Highway 18 W Jackson MS 39209-9421 Ph: (601) 922-0066 |
| NPI Number | 1134414733 |
|---|---|
| Provider Enumeration Date | 06/13/2011 |
| Last Update Date | 06/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134414733 | NPI | - | NPPES |
| 00064746 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 1865-80 (Mississippi) | Primary |
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