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General NPI Number Information
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NPI Number | 1487578597
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Entity Type | Organization
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Legal Business Name | PETAL DENTAL PROPERTIES
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 34 BEECH LANE
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City | PETAL
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State | MS
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Zip | 39465
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Country | US
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Telephone | 601-336-0336
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Fax |
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Provider Business Mailing Address
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Address Line | 6643 U S HIGHWAY 98
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City | HATTIESBURG
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State | MS
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Zip | 39402-8442
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Country | US
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Telephone | 604-336-0336
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Fax | 601-336-0633
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | TINA MYERS
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Credential |
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Telephone | 601-450-6060
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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 |
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License Number State |
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