Healthcare Provider Details

I. General information

NPI: 1639092919
Provider Name (Legal Business Name): TUPELO ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 MEDICAL PARK CIR
TUPELO MS
38801-6595
US

IV. Provider business mailing address

1465 MEDICAL PARK CIR
TUPELO MS
38801-6595
US

V. Phone/Fax

Practice location:
  • Phone: 662-823-3636
  • Fax:
Mailing address:
  • Phone: 662-823-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT JOHNSON CRUMPTON
Title or Position: OWNER
Credential: DMD MS
Phone: 662-823-3636