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General NPI Number Information
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NPI Number | 1619579349
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTAL CLINIC, PA
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | 1555 MEDICAL PARK CIR
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City | TUPELO
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State | MS
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Zip | 38801-6580
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Country | US
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Telephone | 662-844-3315
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Fax | 662-842-8228
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Provider Business Mailing Address
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Address Line | 1555 MEDICAL PARK CIR
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City | TUPELO
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State | MS
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Zip | 38801-6580
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Country | US
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Telephone | 662-844-3315
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Fax | 662-842-8228
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRICE W SUMNER
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Credential | DDS
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Telephone | 662-844-3315
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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 |
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License Number State |
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