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General NPI Number Information
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NPI Number | 1487757027
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Entity Type | Organization
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Legal Business Name | METRO DISCOUNT DENTAL CLINIC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 2310-4TH STREET SUITE B
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City | MERIDIAN
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State | MS
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Zip | 39301
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Country | US
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Telephone | 601-693-4878
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Fax | 601-693-4337
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Provider Business Mailing Address
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Address Line | 2310-4TH STREET STE B
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City | MERIDIAN
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State | MS
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Zip | 39301
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Country | US
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Telephone | 601-693-4878
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Fax | 601-693-4337
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Authorized Official
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Title or Position | BUS. ADMIN.
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Name | MRS. MINNIE P. HUNTER
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Credential | BUS. ADMIN.
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Telephone | 601-693-4878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 160574
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1605-74
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License Number State | MS
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