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General NPI Number Information
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NPI Number | 1912077082
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Entity Type | Organization
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Legal Business Name | CALLAWAY ORTHODONTICS
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 STARR AVE STE D
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City | STARKVILLE
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State | MS
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Zip | 39759
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Country | US
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Telephone | 662-615-4225
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Fax | 662-615-4288
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Provider Business Mailing Address
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Address Line | 100 STARR AVE STE D
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City | STARKVILLE
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State | MS
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Zip | 39759
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Country | US
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Telephone | 662-615-4225
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Fax | 662-615-4288
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Authorized Official
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Title or Position | PRESIDENT
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Name | COOPER E CALLAWAY
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Credential | DMD MS
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Telephone | 662-615-4225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 299197
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License Number State | MS
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