Organization
WARREN INGE DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE PORTER (ACCOUNTS RECEIVABLE COORDINATOR)
(662) 741-2151
Entity
Organization
Contact information
Practice address
702 MARTIN LUTHER KING ST, MOUND BAYOU, MS 38762-9314
(662) 741-2151
(662) 741-2700
Mailing address
702 MARTIN LUTHER KING ROAD, MOUND BAYOU, MS 38762-0900
(662) 741-2151
(662) 741-2700
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013120
—
MS
Enumeration date
11/13/2007
Last updated
07/08/2025
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