Healthcare Provider Details

I. General information

NPI: 1508268087
Provider Name (Legal Business Name): DENTAL SOLUTIONS OF CLINTON, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MORRISON DR
CLINTON MS
39056-5239
US

IV. Provider business mailing address

315 MORRISON DR
CLINTON MS
39056-5239
US

V. Phone/Fax

Practice location:
  • Phone: 601-925-5163
  • Fax: 601-925-5184
Mailing address:
  • Phone: 601-925-5163
  • Fax: 601-925-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2940
License Number StateMS

VIII. Authorized Official

Name: DR. TERRY LAKE GARNER
Title or Position: OWNER
Credential: DMD
Phone: 601-925-5163