Provider Demographics
NPI:1407008337
Name:STARKVILLE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:STARKVILLE PEDIATRIC DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-323-9726
Mailing Address - Street 1:100 BRANDON RD
Mailing Address - Street 2:SUITE W
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2571
Mailing Address - Country:US
Mailing Address - Phone:662-323-9726
Mailing Address - Fax:662-323-9727
Practice Address - Street 1:100 BRANDON RD
Practice Address - Street 2:SUITE W
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2571
Practice Address - Country:US
Practice Address - Phone:662-323-9726
Practice Address - Fax:662-323-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3355-051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty