Individual
DR. PRADEEP ADATROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7135 GETWELL RD STE 100, SOUTHAVEN, MS 38672-9659
(662) 655-4868
Mailing address
7135 GETWELL RD STE 100, SOUTHAVEN, MS 38672-9659
(662) 655-4868
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3727-13
MS
1223P0300X
Periodontics
8586
TN
1223P0300X
Periodontics
PER-505-16
MS
1223P0700X
Prosthodontics
8586
TN
1223P0700X
Prosthodontics
PROS-504-16
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3727-13
DENTAL LICENSE
MS
Enumeration date
09/20/2006
Last updated
06/29/2020
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