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General NPI Number Information
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NPI Number | 1134212038
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Entity Type | Organization
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Legal Business Name | CHICKASAW DENTAL GROUP L. L. C.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 327 N JACKSON ST
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City | HOUSTON
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State | MS
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Zip | 38851
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Country | US
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Telephone | 662-456-9992
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Fax | 662-456-9093
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Provider Business Mailing Address
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Address Line | PO BOX 604
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City | HOUSTON
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State | MS
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Zip | 38851
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Country | US
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Telephone | 662-456-9992
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Fax | 662-456-9093
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. TEENA FREEMAN HORN
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Credential | DMD
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Telephone | 662-456-9992
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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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