Provider Demographics
NPI:1508268087
Name:DENTAL SOLUTIONS OF CLINTON, PLLC
Entity Type:Organization
Organization Name:DENTAL SOLUTIONS OF CLINTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LAKE
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-925-5163
Mailing Address - Street 1:315 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5239
Mailing Address - Country:US
Mailing Address - Phone:601-925-5163
Mailing Address - Fax:601-925-5184
Practice Address - Street 1:315 MORRISON DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5239
Practice Address - Country:US
Practice Address - Phone:601-925-5163
Practice Address - Fax:601-925-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty