| Mississippi Orofacial Pain | |
|
108 S Maple St Ste C Ridgeland MS 39157-2305 | |
| (601) 720-7662 | |
| Not Available |
| Full Name | Mississippi Orofacial Pain |
|---|---|
| Speciality | Dentist |
| Location | 108 S Maple St Ste C, Ridgeland, Mississippi |
| Authorized Official Name and Position | Paul Coleman Riley (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7695672555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mississippi Orofacial Pain 108 S Maple St Ste C Ridgeland MS 39157-2357 Ph: (697) 567-2555 | Mississippi Orofacial Pain 108 S Maple St Ste C Ridgeland MS 39157-2305 Ph: (601) 720-7662 |
| NPI Number | 1639813454 |
|---|---|
| Provider Enumeration Date | 04/27/2022 |
| Last Update Date | 12/28/2023 |
| Medicare PECOS PAC ID | 3072999325 |
|---|---|
| Medicare Enrollment ID | O20230906003568 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639813454 | NPI | - | NPPES |
| 1639813454 | Other | MS | LOCATION NPI |
| 1285640383 | Other | MS | PROVIDER NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X2210X | Dentist - Orofacial Pain | (* (Not Available)) | Primary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| Provider Name | Paul Riley |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1285640383 PECOS PAC ID: 8325418437 Enrollment ID: I20230106000949 |
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