Organization
CHILDREN'S DENTAL CLINIC, PA
Active
Other names
Children's Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRICE W SUMNER DDS (PRESIDENT)
(662) 844-3315
Entity
Organization
Contact information
Practice address
1555 MEDICAL PARK CIR, TUPELO, MS 38801-6580
(662) 844-3315
(662) 842-8228
Mailing address
1555 MEDICAL PARK CIR, TUPELO, MS 38801-6580
(662) 844-3315
(662) 842-8228
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660366
—
MS
Enumeration date
11/09/2020
Last updated
11/09/2020
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