Organization
CHILDREN'S DENTAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH CHET GATEWOOD D.M.D. (OWNER)
(601) 924-4900
Entity
Organization
Contact information
Practice address
539A HIGHWAY 80 W, CLINTON, MS 39056-4193
(601) 924-4900
Mailing address
539A HIGHWAY 80 W, CLINTON, MS 39056-4193
(601) 924-4900
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2696
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660116
—
MS
Enumeration date
03/26/2008
Last updated
06/24/2008
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