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General NPI Number Information
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NPI Number | 1013631571
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Entity Type | Organization
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Legal Business Name | TINDLE FAMILY DENTISTRY PA
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 1021 GLUCKSTADT RD STE 100
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City | MADISON
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State | MS
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Zip | 39110-3911
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Country | US
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Telephone | 769-567-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 GLUCKSTADT RD STE 100
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 769-567-2800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TREVOR TINDLE
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Credential | DMD
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Telephone | 769-567-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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