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604 Brunson Dr Tupelo MS 38801-4947 | |
| (662) 844-0894 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 604 Brunson Dr, Tupelo, Mississippi |
| Authorized Official Name and Position | Sharon Elise Young (OWNER) |
| Authorized Official Contact | 6628440894 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
604 Brunson Dr Tupelo MS 38801-4947 Ph: (662) 844-0894 | 604 Brunson Dr Tupelo MS 38801-4947 Ph: (662) 844-0894 |
| NPI Number | 1962100610 |
|---|---|
| Provider Enumeration Date | 02/22/2023 |
| Last Update Date | 02/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962100610 | NPI | - | NPPES |
| 1699027896 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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