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Contact Information

MAIN STREET FAMILY DENTISTRY PA
627 WEST MAIN ST
TUPELO, MS38804
 Phone: 662-840-0066
 Fax: 662-840-7966
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for MAIN STREET FAMILY DENTISTRY PA

NPI # 1376623074
LBN Legal business name MAIN STREET FAMILY DENTISTRY PA
Authorized official BRETT HILDENBRAND - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 10/17/2006
Last updated 06/02/2015 - About 11 years ago
Identifiers
MS License # 267792
MS License # 324002
MS Medicaid 00660449
MS Medicaid 07158222
MS Medicaid 08823205
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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