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General NPI Number Information
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NPI Number | 1568120194
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Entity Type | Organization
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Legal Business Name | TUTOR FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 03/05/2022
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Provider Practice Location Address
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Address Line | 2815 OLD BRANDON RD
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City | PEARL
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State | MS
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Zip | 39208-4704
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Country | US
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Telephone | 601-497-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 2815 OLD BRANDON RD
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City | PEARL
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State | MS
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Zip | 39208-4704
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Country | US
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Telephone | 601-292-9772
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEATHER KILLEBREW TUTOR
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Credential | DMD
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Telephone | 601-292-9772
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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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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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