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General NPI Number Information
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NPI Number | 1639092919
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Entity Type | Organization
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Legal Business Name | TUPELO ENDODONTICS
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 1465 MEDICAL PARK CIR
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City | TUPELO
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State | MS
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Zip | 38801-6595
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Country | US
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Telephone | 662-823-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 1465 MEDICAL PARK CIR
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City | TUPELO
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State | MS
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Zip | 38801-6595
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Country | US
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Telephone | 662-823-3636
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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. BRENT JOHNSON CRUMPTON
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Credential | DMD MS
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Telephone | 662-823-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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