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General NPI Number Information
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NPI Number | 1558532028
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL SPECIALISTS
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 1540 S MAIN ST SUITE C
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City | GREENVILLE
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State | MS
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Zip | 38701-7055
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Country | US
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Telephone | 662-334-9337
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 S MAIN ST SUITE C
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City | GREENVILLE
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State | MS
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Zip | 38701-7055
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Country | US
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Telephone | 662-334-9337
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Fax |
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. WILLIAM NEIL QUINTON
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Credential | DMD
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Telephone | 662-334-9337
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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 | PEDO-385-05
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License Number State | MS
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