Provider Demographics
NPI:1558464123
Name:RICHARD B WARRINER DDS PA
Entity Type:Organization
Organization Name:RICHARD B WARRINER DDS PA
Other - Org Name:CHILDRENS DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICE
Authorized Official - Middle Name:WARRINER
Authorized Official - Last Name:SUMNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:662-844-3315
Mailing Address - Street 1:1555 MEDICAL PARK CIR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-844-3315
Mailing Address - Fax:662-842-8228
Practice Address - Street 1:1555 MEDICAL PARK CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-844-3315
Practice Address - Fax:662-842-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPEDO4781223P0221X
MSPEDO344001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015476Medicaid