MERIDIAN PEDIATRIC DENTAL GROUP, LLC (NPI# 1356606511) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356606511 |
| Entity Type | Organization |
| Organization Name | MERIDIAN PEDIATRIC DENTAL GROUP, LLC |
| Practice Address |
1922 23rd Ave Meridian MS 39301 |
| Practice Telephone | 6014828986 |
| Practice Fax Number | 6014826100 |
| Mailing Telephone | 6014828986 |
| Mailing Fax Number | 6014826100 |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2012-07-12 |
| Authorized Official Name | DR. SHELLEY WILKERSON ELLIS (PEDIATRIC DENTIST) |
| Authorized Official Telephone | 6014828986 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
MS | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00060313 | 05 | |
| MS | SWE | 01035561 | 01 |
| Street Address |
1922 23RD AVE |
| City | MERIDIAN |
| State | MS |
| Zip Code | 39301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710068739 | J Britt Mccarty | Dentist | 1922 23rd Ave, Meridian, MS 39301-3107 | 2006-10-17 |
| 1700167145 | J. Britt Mccarty Dmd Pa | Clinic/Center | 1922 23rd Ave, Meridian, MS 39301-3107 | 2011-08-30 |
| 1760646509 | Shelley Wilkerson Mcdonald | Dentist | 1922 23rd Ave, Meridian, MS 39301-3107 | 2008-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407460439 | Kayla Lee Monsour | Pharmacist | 1415 24th Avenue, Meridian, MS 39301 | 2020-09-08 |
| 1306478359 | K&r Optical Solutions Corporation | Eyewear Supplier (Equipment, not the service) | 3126 8th St., Suite A, Meridian, MS 39301 | 2020-02-07 |
| 1912537317 | Courtney M Hollie | Counselor | 1054 Ms-19, Meridian, MS 39301 | 2020-01-24 |
| 1932636495 | Rcg Mississippi, Inc. | Clinic/Center | 1300 38th Ave E, Meridian, MS 39301 | 2017-05-16 |
| 1811428915 | Tierria Mcglothin | Nurse Practitioner | 1054 Highway 19 S, Meridian, MS 39301 | 2017-03-21 |
| 1154869303 | Lindsay Nemanich | Physical Therapist | 3716 Ms-39, Meridian, MS 39301 | 2017-02-08 |
| 1700323599 | Wal-mart Stores East Lp | Pharmacy | 3310-a Highway 39 North, Meridian, MS 39301 | 2017-01-31 |
| 1972977460 | Southeast Pharmacy LLC | Pharmacy | 2402 Long Creek Road, Meridian, MS 39301 | 2015-11-20 |
| 1235508342 | East Mississippi Oral & Facial Surgery, LLC | Clinic/Center | 1212 24th Avenue, Meridian, MS 39301 | 2015-09-18 |
| 1831580778 | Clarkdale Pharmacy and Gifts LLC | Pharmacy | 6935c Hwy 145, Meridian, MS 39301 | 2015-02-13 |
| Find all providers in zip 39301 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902325749 | Cherry Lane Kids Dentistry | Dentist | 1558 N Crestmont Dr Ste A, Meridian, ID 83642-2194 | 2017-09-13 |
| 1720447097 | Brock Coletti | Dentist | 3235 N Towerbridge Way Ste 200, Meridian, ID 83646-5721 | 2016-02-15 |
| 1811156722 | Meridian Pediatric Dentistry, Pllc | Dentist | 1550 E Heritage Park St Ste 150, Meridian, ID 83646-5886 | 2008-06-05 |
| 1659546174 | Randall Parley Blair | Dentist | 37 W Archerfield St Ste 100, Meridian, ID 83646-6587 | 2008-04-25 |
| 1710068739 | J Britt Mccarty | Dentist | 1922 23rd Ave, Meridian, MS 39301-3107 | 2006-10-17 |
| 1407801939 | Toby O Merriman | Dentist | 1550 E Heritage Park St, Ste 150, Meridian, ID 83646-5886 | 2006-05-23 |
| 1326098682 | Joel E Whitt | Dentist | 3235 N Towerbridge Way, Suite 200, Meridian, ID 83646 | 2006-05-10 |
| 1962466292 | Lawrence Wayne Meadors | Dentist | 2300 W Everest Ln, Suite 125, Meridian, ID 83646-5925 | 2006-04-13 |
| 1972863678 | Dental Care for Kids | Dentist | 3235 N Towerbridge Way, Suite 200, Meridian, ID 83646-5721 | 2012-05-29 |
| 1760646509 | Shelley Wilkerson Mcdonald | Dentist | 1922 23rd Ave, Meridian, MS 39301-3107 | 2008-07-10 |
| Find all providers in MERIDIAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.