Children's Dental Clinic, PA

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CHILDREN'S DENTAL CLINIC, PA

Doing business as

Children's Dental Clinic

Practice address

1555 Medical Park Cir
Tupelo, MS 38801-6580

Phone

(662) 844-3315

Fax

(662) 842-8228

NPI assigned

Nov 9, 2020

Last updated

Nov 9, 2020By 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. Trice W Sumner, DDSNPI 1649373218

Title

President

Phone

(662) 844-3315

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Children's Dental Clinic Doing business as

Electronic endpoints 1

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.

• Trice Warriner Sumner, DDS

  • Pediatric Dentistry
  • Tupelo, MS
  • NPI 1649373218
  NPD Authorized official
• Richard Bascomb Warriner III, DDS

  • Pediatric Dentistry
  • Tupelo, MS
  • NPI 1821191495
  NPD (past)

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

{
    "created_epoch": "1604880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604880000000",
    "number": "1619579349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 MEDICAL PARK CIR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016580",
            "telephone_number": "662-844-3315",
            "fax_number": "662-842-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 MEDICAL PARK CIR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016580",
            "telephone_number": "662-844-3315",
            "fax_number": "662-842-8228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S DENTAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-09",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-08",
        "status": "A",
        "authorized_official_last_name": "SUMNER",
        "authorized_official_first_name": "TRICE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-844-3315",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00660366",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "bracket.email",
            "affiliation": "N",
            "endpointDescription": "Mailprotector Bracket encrypted email",
            "address_1": "1555 Medical Park Cir",
            "city": "Tupelo",
            "state": "MS",
            "country_code": "US",
            "postal_code": "388016580",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Children's Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa M Chatham, MS CCC-SP
• Gail Frances Cherry
• Cheyenne Total Care LLC
• Michael Scott Childers, PT, DPT
• Children's Clinic of Tupelo, PA
• Jessica Braddock Childs, AGNP
• David J Chisholm, CRNA
• Suzanne Chittom, M.S., OTR/L
• Leslie Chrestman, M.ED
• James Leland Chrisman, D.D.S.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2020; 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.