PEDIATRIC DENTISTRY OF RIDGELAND PLLC NPI 1902456247

NPI Information

PEDIATRIC DENTISTRY OF RIDGELAND, PLLC is a pediatric dentistry dentist in Ridgeland, 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. PEDIATRIC DENTISTRY OF RIDGELAND, PLLC NPI is 1902456247. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

297 HIGHWAY 51 STE D
RIDGELAND, MS
ZIP 39157-423
Phone: (601) 856-4428
Fax: (601) 856-3310

The provider's authorized official is Tiffany Priscilla Green .
The authorized official title is Pediatric Dentist and has the following contact phone number (601) 497-2550.

The CLIA number assigned to this NPI record is 25D2292301 - other - ped prescribed day ctr with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/18/2019 and was last updated on 9/18/2019.

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:

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