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General NPI Number Information
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NPI Number | 1760995963
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Entity Type | Organization
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Legal Business Name | LD-TUPELO, LLC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 1763 CLIFF GOOKIN BLVD
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City | TUPELO
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State | MS
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Zip | 38801-6723
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Country | US
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Telephone | 662-842-2802
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Fax | 866-251-3105
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Provider Business Mailing Address
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Address Line | 1763 CLIFF GOOKIN BLVD
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City | TUPELO
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State | MS
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Zip | 38801-6723
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Country | US
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Telephone | 662-842-2802
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Fax | 866-251-3105
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Authorized Official
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Title or Position | ADMIN DIRECTOR
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Name | LAUREN S DAIGNEAULT
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Credential | BA, MA
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Telephone | 256-783-9468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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