Childrens Dental Clinic | |
1555 Medical Park Cir Tupelo MS 38801 | |
(662) 844-3315 | |
(662) 842-8228 |
Full Name | Childrens Dental Clinic |
---|---|
Speciality | Dentist - Pediatric Dentistry |
Location | 1555 Medical Park Cir, Tupelo, Mississippi |
Authorized Official Name and Position | Trice Warriner Sumner (PEDIATRIC DENTIST OWNER) |
Authorized Official Contact | 6628443315 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Childrens Dental Clinic 1555 Medical Park Cir Tupelo MS 38801 Ph: (662) 844-3315 | Childrens Dental Clinic 1555 Medical Park Cir Tupelo MS 38801 Ph: (662) 844-3315 |
NPI Number | 1558464123 |
---|---|
Provider Enumeration Date | 09/07/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1558464123 | NPI | - | NPPES |
09015476 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0221X | Dentist - Pediatric Dentistry | PEDO478 (Mississippi) | Primary |
1223P0221X | Dentist - Pediatric Dentistry | PEDO34400 (Mississippi) | Secondary |
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