MEDICARE: CRONIN DENTISTRY OF COLUMBIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1477217693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRONIN DENTISTRY OF COLUMBIA, LLC

Provider Business Mailing Address
First Line	:	440 BROAD STREET
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429
Country	:	US
Telephone Number	:	601-736-1761
Fax Number	:	601-736-1766

Provider Business Practice Location Address
First Line	:	440 BROAD STREET
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429
Country	:	US
Telephone Number	:	601-736-1761
Fax Number	:	601-736-1766

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	MR. CHRISTOPHER KELLY CRONIN
Credential	:	DMD
Telephone Number	:	601-736-1761

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	02/06/2026

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