North Mississippi Dental Specialists, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

3136-00 Issued in MS

Legal business name

NORTH MISSISSIPPI DENTAL SPECIALISTS, PLLC

Doing business as

the children's dental center

Practice address

2925 Nail Rd E Ste 103
Southaven, MS 38672-6715

Phone

(662) 893-7337

Fax

(662) 893-7881

NPI assigned

Oct 4, 2006

Last updated

May 23, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Clyde Armstrong Musgrave, D.M.D.NPI 1194825299

Title

Pediatric Dentist

Phone

(662) 893-7337

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• the children's dental center Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Clyde Armstrong Musgrave, D.M.D.

  • Pediatric Dentistry
  • Southaven, MS
  • NPI 1194825299
  NPD (past) Authorized official
• Bryan Truong, DDS, MDS

  • Pediatric Dentistry
  • Southaven, MS
  • NPI 1184465478
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653264000000",
    "number": "1578658373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 NAIL RD E STE 103",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726715",
            "telephone_number": "662-893-7337",
            "fax_number": "662-893-7881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 NAIL RD E STE 103",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726715",
            "telephone_number": "662-893-7337",
            "fax_number": "662-893-7881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH MISSISSIPPI DENTAL SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A",
        "authorized_official_last_name": "MUSGRAVE",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_middle_name": "ARMSTRONG",
        "authorized_official_title_or_position": "PEDIATRIC DENTIST",
        "authorized_official_telephone_number": "662-893-7337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": "3136-00",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016069",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "the children's dental center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "the children's dental center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Northeast Mississippi Health Care, Inc (DeSoto Community Health Center)
• Northwest Mississippi Otolaryngology Head & Neck Surgery, LLC

• Pediatric Dentistry in Southaven, MS
• Providers in Southaven, MS by specialty
• Pediatric Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.