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General NPI Number Information
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NPI Number | 1558692582
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Entity Type | Organization
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Legal Business Name | TATE FAMILY DENTISTRY, L.L.C.
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 26 WESTWOOD DRIVE
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City | SENATOBIA
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State | MS
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Zip | 38668
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Country | US
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Telephone | 662-562-4300
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Fax | 662-562-4303
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Provider Business Mailing Address
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Address Line | 26 WESTWOOD DRIVE
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City | SENATOBIA
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State | MS
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Zip | 38668
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Country | US
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Telephone | 662-562-4300
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Fax | 662-562-4300
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BRANT HUME KAIRIT
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Credential | D.M.D.
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Telephone | 662-501-2000
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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 |
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License Number State |
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