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General NPI Number Information
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NPI Number | 1407008337
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Entity Type | Organization
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Legal Business Name | STARKVILLE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 100 BRANDON RD SUITE W
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City | STARKVILLE
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State | MS
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Zip | 39759-2571
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Country | US
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Telephone | 662-323-9726
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Fax | 662-323-9727
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Provider Business Mailing Address
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Address Line | 100 BRANDON RD SUITE W
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City | STARKVILLE
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State | MS
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Zip | 39759-2571
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Country | US
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Telephone | 662-323-9726
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Fax | 662-323-9727
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Authorized Official
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Title or Position | OWNER
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Name | TAMMI T LOCKHART
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Credential | D.M.D.
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Telephone | 662-323-9726
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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 | 3355-05
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License Number State | MS
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