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General NPI Number Information
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NPI Number | 1104552918
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Entity Type | Individual
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Provider Name | CYNTHIA LYNNE SENIOR RDH
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Gender | Female
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 2500 N STATE ST
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City | JACKSON
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State | MS
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Zip | 39216-4500
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Country | US
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Telephone | 601-815-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 407 WARWICK RD
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City | CLINTON
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State | MS
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Zip | 39056-6212
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Country | US
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Telephone | 228-861-1545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 3531-05DH
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License Number State | MS
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