Organization
KELLUM DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUNDI B. LITTLE (OFFICE MANAGER)
(662) 842-5080
Entity
Organization
Contact information
Practice address
505 ROBINS ST, TUPELO, MS 38804-3715
(662) 842-5080
(662) 842-5896
Mailing address
PO BOX 1486, TUPELO, MS 38802-1486
(662) 842-5080
(662) 842-5896
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1782-77
MS
261QD0000X
Dental Clinic/Center
2554-90
MS
Other
Enumeration date
05/03/2007
Last updated
08/22/2020
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