=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427145044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE DENTAL SOLUTION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 07/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 MORRISON DRIVE
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 89056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-925-5163
-----------------------------------------------------
Fax | 601-925-5184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 MORRISON DRIVE
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 89056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-925-5163
-----------------------------------------------------
Fax | 601-925-5184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | MARTHA LOUISE LEWIS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 601-925-5163
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 255990
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------