Provider Demographics
NPI:1548454838
Name:THE FAMILY DENTAL CENTER OF CLINTON
Entity type:Organization
Organization Name:THE FAMILY DENTAL CENTER OF CLINTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:STRANGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-924-2446
Mailing Address - Street 1:505 SPRINGRIDGE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5612
Mailing Address - Country:US
Mailing Address - Phone:601-924-2446
Mailing Address - Fax:601-924-6030
Practice Address - Street 1:505 SPRINGRIDGE RD
Practice Address - Street 2:SUITE C
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5612
Practice Address - Country:US
Practice Address - Phone:601-924-2446
Practice Address - Fax:601-924-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2888951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1134282387OtherINDIVIDUAL NPI