Provider Demographics
NPI:1558692582
Name:TATE FAMILY DENTISTRY, L.L.C.
Entity Type:Organization
Organization Name:TATE FAMILY DENTISTRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:HUME
Authorized Official - Last Name:KAIRIT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-501-2000
Mailing Address - Street 1:26 WESTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668
Mailing Address - Country:US
Mailing Address - Phone:662-562-4300
Mailing Address - Fax:662-562-4300
Practice Address - Street 1:26 WESTWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668
Practice Address - Country:US
Practice Address - Phone:662-562-4300
Practice Address - Fax:662-562-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty