Provider Demographics
NPI:1558532028
Name:PEDIATRIC DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL SPECIALISTS
Other - Org Name:W. NEIL QUINTON, DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:QUINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-334-9337
Mailing Address - Street 1:1540 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-7055
Mailing Address - Country:US
Mailing Address - Phone:662-334-9337
Mailing Address - Fax:
Practice Address - Street 1:1540 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7055
Practice Address - Country:US
Practice Address - Phone:662-334-9337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPEDO-385-051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09854764Medicaid