Provider Demographics
NPI:1023290012
Name:MISSISSIPPI DENTISTRY FOR CHILDREN, INC
Entity type:Organization
Organization Name:MISSISSIPPI DENTISTRY FOR CHILDREN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-250-4115
Mailing Address - Street 1:1071 HIGHWAY 51 AND 98
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-8712
Mailing Address - Country:US
Mailing Address - Phone:601-250-4115
Mailing Address - Fax:601-250-4116
Practice Address - Street 1:1071 HIGHWAY 51 AND 98
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-8712
Practice Address - Country:US
Practice Address - Phone:601-250-4115
Practice Address - Fax:601-250-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06708221Medicaid