| The Children's Dental Center | |
|
2925 Nail Rd E Ste 103 Southaven MS 38672-6715 | |
| (662) 893-7337 | |
| (662) 893-7881 |
| Full Name | The Children's Dental Center |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2925 Nail Rd E Ste 103, Southaven, Mississippi |
| Authorized Official Name and Position | Clyde Armstrong Musgrave (PEDIATRIC DENTIST) |
| Authorized Official Contact | 6628937337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Children's Dental Center 2925 Nail Rd E Ste 103 Southaven MS 38672-6715 Ph: (662) 893-7337 | The Children's Dental Center 2925 Nail Rd E Ste 103 Southaven MS 38672-6715 Ph: (662) 893-7337 |
| NPI Number | 1578658373 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 05/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578658373 | NPI | - | NPPES |
| 09016069 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 3136-00 (Mississippi) | Primary |
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