Provider Demographics
NPI:1336642578
Name:SENATOBIA DENTAL STUDIO PLLC
Entity Type:Organization
Organization Name:SENATOBIA DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:GRIFFIN
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-562-9609
Mailing Address - Street 1:133 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 N CENTER ST
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2130
Practice Address - Country:US
Practice Address - Phone:662-562-9609
Practice Address - Fax:662-562-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty