PROF. CLYDE ARMSTRONG MUSGRAVE D.M.D. NPI 1194825299

NPI Information

NPI: 1194825299
Provider Name: PROF. CLYDE ARMSTRONG MUSGRAVE, D.M.D.
Classification: Dentist - 1223P0221X
Entity Type: Individual

Specialization: Pediatric Dentistry

Address:
3964 GOODMAN RD E STE 128
SOUTHAVEN, MS
ZIP 38672
Phone: (662) 893-7337
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PROF. Clyde Armstrong Musgrave, D.M.D. is a pediatric dentistry dentist in Southaven, MS. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. PROF. Clyde Armstrong Musgrave, D.M.D. NPI is 1194825299. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3964 GOODMAN RD E STE 128
SOUTHAVEN, MS
ZIP 38672-494
Phone: (662) 893-7337
Fax: (662) 893-7881

The enumeration date for this NPI number is 9/25/2006 and was last updated on 8/8/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0221X	Dentist	Pediatric Dentistry	3136-00	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00660434	MEDICAID	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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