# CHILDREN'S DENTAL CLINIC, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Children's Dental Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619579349
- **Authorized official:** DR. TRICE W SUMNER DDS (PRESIDENT)
- **Authorized official phone:** (662) 844-3315

## Contact information

- **Practice address:** 1555 MEDICAL PARK CIR, TUPELO, MS 38801-6580
- **Practice address phone:** (662) 844-3315
- **Practice address fax:** (662) 842-8228
- **Mailing address:** 1555 MEDICAL PARK CIR, TUPELO, MS 38801-6580
- **Mailing address phone:** (662) 844-3315
- **Mailing address fax:** (662) 842-8228

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 11/09/2020
- **Last updated:** 11/09/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00660366 | — | MS |