Healthcare Provider Details

I. General information

NPI: 1558532028
Provider Name (Legal Business Name): PEDIATRIC DENTAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N MEDICAL PARK DR
GREENVILLE MS
38703-7239
US

IV. Provider business mailing address

1550 N MEDICAL PARK DR
GREENVILLE MS
38703-7239
US

V. Phone/Fax

Practice location:
  • Phone: 662-334-9337
  • Fax: 662-334-9897
Mailing address:
  • Phone: 662-334-9337
  • Fax: 662-334-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberPEDO-385-05
License Number StateMS

VIII. Authorized Official

Name: DR. WILLIAM NEIL QUINTON
Title or Position: OWNER/PEDIATRIC DENTIST
Credential: DMD
Phone: 662-334-9337