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General NPI Number Information
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NPI Number | 1164938650
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF CORINTH
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 1500 N HARPER RD #5 PEDIATRIC DENTISTRY OF CORINTH
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City | CORINTH
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State | MS
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Zip | 38834
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Country | US
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Telephone | 662-872-3031
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Fax | 662-510-0190
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Provider Business Mailing Address
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Address Line | 1500 N HARPER RD #5 PEDIATRIC DENTISTRY OF CORINTH
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City | CORINTH
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State | MS
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Zip | 38834
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Country | US
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Telephone | 662-872-3031
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Fax | 662-510-0190
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID KENNON CURTIS SR.
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Credential | D.M.D.
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Telephone | 662-327-0995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2264-86
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License Number State | MS
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