Provider Demographics
NPI:1487757027
Name:METRO DISCOUNT DENTAL CLINIC
Entity type:Organization
Organization Name:METRO DISCOUNT DENTAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUS. ADMIN.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINNIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:BUS ADMIN
Authorized Official - Phone:601-693-4878
Mailing Address - Street 1:2310-4TH STREET
Mailing Address - Street 2:STE B
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-693-4878
Mailing Address - Fax:601-693-4337
Practice Address - Street 1:2310-4TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-693-4878
Practice Address - Fax:601-693-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS160574122300000X
MS1605-74122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09202773Medicaid