Provider Demographics
NPI:1740798503
Name:CLD MEDICAL ENTERPRISES PLLC
Entity Type:Organization
Organization Name:CLD MEDICAL ENTERPRISES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-953-2410
Mailing Address - Street 1:671 MUIRWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3631
Mailing Address - Country:US
Mailing Address - Phone:601-953-2410
Mailing Address - Fax:601-936-0088
Practice Address - Street 1:212 DRAPERTON CT STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3905
Practice Address - Country:US
Practice Address - Phone:601-936-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18187208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty