MEDICARE: PEDIATRIC DENTAL SPECIALISTS

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	1223P0221X	Pediatric Dentistry	PEDO-385-05	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558532028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC DENTAL SPECIALISTS

Provider Business Mailing Address
First Line	:	1550 N MEDICAL PARK DR
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-7239
Country	:	US
Telephone Number	:	662-334-9337
Fax Number	:	662-334-9897

Provider Business Practice Location Address
First Line	:	1550 N MEDICAL PARK DR
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-7239
Country	:	US
Telephone Number	:	662-334-9337
Fax Number	:	662-334-9897

Authorized Official
Title or Position	:	OWNER/PEDIATRIC DENTIST
Name	:	DR. WILLIAM NEIL QUINTON
Credential	:	DMD
Telephone Number	:	662-334-9337

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	12/24/2025

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