# PEDIATRIC DENTISTRY OF RIDGELAND, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902456247
- **Authorized official:** TIFFANY PRISCILLA GREEN DMD (PEDIATRIC DENTIST)
- **Authorized official phone:** (601) 497-2550

## Contact information

- **Practice address:** 297 HIGHWAY 51 STE D, RIDGELAND, MS 39157-3423
- **Practice address phone:** (601) 856-4428
- **Practice address fax:** (601) 856-3310
- **Mailing address:** 297 HIGHWAY 51 STE D, RIDGELAND, MS 39157-3423
- **Mailing address phone:** (601) 856-4428
- **Mailing address fax:** (601) 856-3310

## Taxonomy

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

## Other

- **Enumeration date:** 09/18/2019
- **Last updated:** 09/18/2019