Healthcare Provider Details

I. General information

NPI: 1417307810
Provider Name (Legal Business Name): CHRISTOPHER PRICE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S LAUREL ST
SUMMIT MS
39666-9349
US

IV. Provider business mailing address

PO BOX 789
SUMMIT MS
39666-0789
US

V. Phone/Fax

Practice location:
  • Phone: 601-276-7915
  • Fax:
Mailing address:
  • Phone: 601-276-7915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3876-16
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: