| North Mississippi Oral & Maxillofacial Surgery Associates, Pa | |
|
1043 S Madison St Tupelo MS 38801-6309 | |
| (662) 842-8200 | |
| (662) 844-3157 |
| Full Name | North Mississippi Oral & Maxillofacial Surgery Associates, Pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Pathology |
| Location | 1043 S Madison St, Tupelo, Mississippi |
| Authorized Official Name and Position | Karen Lynn Costello (OFFICE MANAGER) |
| Authorized Official Contact | 6628428200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| North Mississippi Oral & Maxillofacial Surgery Associates, Pa 1043 S Madison St Tupelo MS 38801-6309 Ph: (662) 842-8200 | North Mississippi Oral & Maxillofacial Surgery Associates, Pa 1043 S Madison St Tupelo MS 38801-6309 Ph: (662) 842-8200 |
| NPI Number | 1831104793 |
|---|---|
| Provider Enumeration Date | 07/29/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831104793 | NPI | - | NPPES |
| 05021312 | Medicaid | MS | |
| 0660076 | Medicaid | MS | |
| 00063290 | Medicaid | MS | |
| 00660372 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | MS162174 (Mississippi) | Primary |
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