KELLUM DENTAL CLINIC (NPI# 1528280880) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528280880 |
| Entity Type | Organization |
| Organization Name | KELLUM DENTAL CLINIC |
| Practice Address |
505 Robins St Tupelo MS 38804-3715 |
| Mailing Address |
Po Box 1486 Tupelo MS 38802-1486 |
| Practice Telephone | 6628425080 |
| Practice Fax Number | 6628425896 |
| Mailing Telephone | 6628425080 |
| Mailing Fax Number | 6628425896 |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | SHAUNDI B. LITTLE (OFFICE MANAGER) |
| Authorized Official Telephone | 6628425080 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QD0000X |
Clinic/Center Specialization: Dental |
2554-90 | MS | Ambulatory Health Care Facilities |
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
1782-77 | MS | Ambulatory Health Care Facilities |
| Street Address |
505 ROBINS ST |
| City | TUPELO |
| State | MS |
| Zip Code | 38804-3715 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710991492 | Daniel H. Kellum | Dentist | 505 Robins St, Tupelo, MS 38804-3715 | 2006-07-28 |
| 1205840998 | Thomas N. Kellum | Dentist | 505 Robins St, Tupelo, MS 38804-3715 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548874159 | Susan Me'chelle Oliver | Nurse Practitioner | 874 Barnes Crossing Road, Tupelo, MS 38804 | 2020-09-01 |
| 1134762784 | Kimberly J Adams | Occupational Therapy Assistant | 90 Clark Ave, Tupelo, MS 38804 | 2019-10-25 |
| 1790270924 | Megan Guntharp | Occupational Therapist | 960 Commonwealth Boulevard, Tupelo, MS 38804 | 2018-06-29 |
| 1154867562 | Urologic Ambulatory Surgery Center, LLC | Clinic/Center | 3353 N Gloster Street, Suite 300, Tupelo, MS 38804 | 2017-01-09 |
| 1790235919 | Dr Scott Dickinson D.m. D. PC | Dentist | 3999 N Gloster Street, Tupelo, MS 38804 | 2016-10-12 |
| 1326496621 | Angela Estes | Occupational Therapist | County Road 1279 House#197, Tupelo, MS 38804 | 2016-05-26 |
| 1316300080 | Eric Wade Tillotson | Family Medicine | 1665 South Green Street, Tupelo, MS 38804 | 2016-03-31 |
| 1104238898 | Stella M. Johnson | Social Worker | 2292 Camelot Cir, Tupelo, MS 38804 | 2014-05-29 |
| 1821437351 | Lenka Petersen | Student in an Organized Health Care Education/Training Program | 1665 S Green St., Nmmc, Tupelo, MS 38804 | 2013-06-18 |
| 1083966303 | Jessica M Baskett | Counselor | 398 E Main St, Tupelo, MS 38804 | 2012-10-10 |
| Find all providers in zip 38804 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336647924 | Murphree's Smile Designers | Clinic/Center | 602 Pegram Dr, Tupelo, MS 38801-6322 | 2018-01-29 |
| 1760995963 | Premier Dental | Clinic/Center | 1763 Cliff Gookin Blvd, Tupelo, MS 38801-6723 | 2017-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144838970 | Superior Smiles, LLC | Clinic/Center | 16690 E Main St, Louisville, MS 39339-2750 | 2020-07-17 |
| 1255991196 | Sky Family Dental, LLC | Clinic/Center | 200 Meadowlane Street, Eupora, MS 39744 | 2019-06-13 |
| 1851886857 | Grenada Dental Clinic Pllc | Clinic/Center | 1800 Hill Dr Ste A, Grenada, MS 38901-5071 | 2018-06-22 |
| 1467940627 | Ld-columbus LLC | Clinic/Center | 611 Leigh Dr, Columbus, MS 39705-3036 | 2018-04-24 |
| 1821592734 | Integrity Dental Clinic, Pllc | Clinic/Center | 201 E Layfair Dr Ste 100, Flowood, MS 39232-7604 | 2018-03-23 |
| 1144735481 | Peoples Dental Pa | Clinic/Center | 1016 Louisville St Ste G, Starkville, MS 39759-3953 | 2017-12-08 |
| 1366956419 | Bradley M Stewart Dmd LLC | Clinic/Center | 6855 Crumpler Blvd Ste 100, Olive Branch, MS 38654-1930 | 2017-11-28 |
| 1316458136 | Reservoir Smiles Dentistry, Pllc | Clinic/Center | 1149 Old Fannin Rd Ste 26, Brandon, MS 39047-9244 | 2017-10-19 |
| 1356851752 | Oakdale Family Dentistry | Clinic/Center | 2139 Hwy 471, Flowood, MS 39232 | 2017-10-11 |
| 1073985925 | Decatur Dental, LLC | Clinic/Center | 68 Fourth Ave, Decatur, MS 39327-9713 | 2015-10-30 |
| Find all providers with the same taxonomy | ||||
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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.