NPIMap

Organization Active NPI

LD-Tupelo, LLC

Doing business as Premier Dental

  • Dental Clinic/Center
  • Tupelo, MS
National Provider Identifier
1760995963
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
LD-TUPELO, LLC
Doing business as
Premier Dental
Practice address
1763 Cliff Gookin Blvd
Tupelo, MS 38801-6723
Phone
(662) 842-2802
Fax
(866) 251-3105
NPI assigned
Nov 9, 2017
Last updated
Jul 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Authorized official

Name
Lauren S Daigneault, BA, MA
Title
Admin Director
Phone
(256) 783-9468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

1763 Cliff Gookin Blvd
Tupelo, MS 38801-6723

Mailing address

1763 Cliff Gookin Blvd
Tupelo, MS 38801-6723
Phone (662) 842-2802

Other names 1

  • Premier Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1763 Cliff Gookin Blvd
Tupelo, MS 38801
Phone (662) 842-2802

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1510185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688688000000",
    "number": "1760995963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1763 CLIFF GOOKIN BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016723",
            "telephone_number": "662-842-2802",
            "fax_number": "866-251-3105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1763 CLIFF GOOKIN BLVD",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016723",
            "telephone_number": "662-842-2802",
            "fax_number": "866-251-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LD-TUPELO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-09",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A",
        "authorized_official_last_name": "DAIGNEAULT",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMIN DIRECTOR",
        "authorized_official_telephone_number": "256-783-9468",
        "authorized_official_credential": "BA, MA"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; 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.