Healthcare Provider Details

I. General information

NPI: 1346992815
Provider Name (Legal Business Name): MILLING PEDIATRIC DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 CRANE RIDGE DR STE B
JACKSON MS
39216-4944
US

IV. Provider business mailing address

1855 CRANE RIDGE DR STE B
JACKSON MS
39216-4944
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-8585
  • Fax:
Mailing address:
  • Phone: 601-982-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE BELL
Title or Position: OM
Credential:
Phone: 601-982-8585