| Tullos Family Dentistry, Pa | |
|
276 Magnolia Dr Raleigh MS 39153-6016 | |
| (601) 782-9909 | |
| (601) 782-9133 |
| Full Name | Tullos Family Dentistry, Pa |
|---|---|
| Speciality | Dentist |
| Location | 276 Magnolia Dr, Raleigh, Mississippi |
| Authorized Official Name and Position | Stephanie Sullivan Tullos (DENTIST) |
| Authorized Official Contact | 6017829909 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tullos Family Dentistry, Pa 276 Magnolia Dr Raleigh MS 39153-6016 Ph: (601) 782-9909 | Tullos Family Dentistry, Pa 276 Magnolia Dr Raleigh MS 39153-6016 Ph: (601) 782-9909 |
| NPI Number | 1467519827 |
|---|---|
| Provider Enumeration Date | 01/03/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467519827 | NPI | - | NPPES |
| 00529717 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3265-03 (Mississippi) | Primary |
Raleigh Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 207 Sylvarena Ave, Raleigh, MS 39153 Phone: 601-782-9206 |