Healthcare Provider Details

I. General information

NPI: 1780408658
Provider Name (Legal Business Name): ANDY YUANZHE LI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N INDUSTRIAL RD STE A
TUPELO MS
38801-3441
US

IV. Provider business mailing address

101 N INDUSTRIAL RD STE A
TUPELO MS
38801-3441
US

V. Phone/Fax

Practice location:
  • Phone: 662-418-1238
  • Fax:
Mailing address:
  • Phone: 662-418-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111178
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: