Provider Demographics
NPI:1417414350
Name:MID SOUTH ENDODONTICS PLLC
Entity Type:Organization
Organization Name:MID SOUTH ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LOWERY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-890-3196
Mailing Address - Street 1:5740 GETWELL RD STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6346
Mailing Address - Country:US
Mailing Address - Phone:662-890-3196
Mailing Address - Fax:662-890-3197
Practice Address - Street 1:1918 EXETER RD UNIT 1
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2970
Practice Address - Country:US
Practice Address - Phone:662-890-3196
Practice Address - Fax:662-890-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty