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General NPI Number Information
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NPI Number | 1578658373
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Entity Type | Organization
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Legal Business Name | NORTH MISSISSIPPI DENTAL SPECIALISTS, PLLC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 2925 NAIL RD E STE 103
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City | SOUTHAVEN
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State | MS
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Zip | 38672-6715
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Country | US
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Telephone | 662-893-7337
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Fax | 662-893-7881
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Provider Business Mailing Address
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Address Line | 2925 NAIL RD E STE 103
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City | SOUTHAVEN
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State | MS
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Zip | 38672-6715
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Country | US
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Telephone | 662-893-7337
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Fax | 662-893-7881
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. CLYDE ARMSTRONG MUSGRAVE
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Credential | D.M.D.
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Telephone | 662-893-7337
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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 | 3136-00
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License Number State | MS
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