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General NPI Number Information
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NPI Number | 1417414350
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Entity Type | Organization
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Legal Business Name | MID SOUTH ENDODONTICS PLLC
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 1918 EXETER RD UNIT 1
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City | GERMANTOWN
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State | TN
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Zip | 38138-2970
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Country | US
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Telephone | 662-890-3196
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Fax | 662-890-3197
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Provider Business Mailing Address
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Address Line | 5740 GETWELL RD STE A
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City | SOUTHAVEN
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State | MS
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Zip | 38672-6346
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Country | US
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Telephone | 662-890-3196
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Fax | 662-890-3197
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Authorized Official
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Title or Position | MEMBER
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Name | MICHAEL PATRICK LOWERY
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Credential | DMD
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Telephone | 662-890-3196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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