Healthcare Provider Details

I. General information

NPI: 1740170448
Provider Name (Legal Business Name): DELTA PEDIATRIC DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 CLOVERDALE DR
GREENVILLE MS
38701-8321
US

IV. Provider business mailing address

1143 CLOVERDALE DR
GREENVILLE MS
38701-8321
US

V. Phone/Fax

Practice location:
  • Phone: 769-798-0124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JULIANNA STEINLE
Title or Position: PRESIDENT
Credential: DMD
Phone: 769-798-0124