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MAIN STREET FAMILY DENTISTRY PA NPI 1376623074


NPI Information

NPI: 1376623074
Provider Name: MAIN STREET FAMILY DENTISTRY PA
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
627 WEST MAIN ST
TUPELO, MS
ZIP 38804
Phone: (662) 840-0066
Get Directions

MAIN STREET FAMILY DENTISTRY PA is a general practice dentist in Tupelo, MS. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. MAIN STREET FAMILY DENTISTRY PA NPI is 1376623074. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

627 WEST MAIN ST
TUPELO, MS
ZIP 38804
Phone: (662) 840-0066
Fax: (662) 840-7966

The provider's authorized official is Brett M Hildenbrand .
The authorized official title is President and has the following contact phone number (662) 840-0066.

The enumeration date for this NPI number is 10/17/2006 and was last updated on 6/2/2015.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223G0001XDentistGeneral Practice324002MISSISSIPPINo
21223G0001XDentistGeneral Practice267792MISSISSIPPIYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
107158222MEDICAIDMISSISSIPPI
200660449MEDICAIDMISSISSIPPI
308823205MEDICAIDMISSISSIPPI

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: 4/28/2024

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