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Organization
MP DENTAL, LLC
Active
Organization
MP DENTAL, LLC
Active
Other names
Jefferson Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY CROWE (DIRECTOR OF OPERATIONS)
(770) 297-0401
Entity
Organization
Contact information
Practice address
1679 OLD PENDERGRASS RD, JEFFERSON, GA 30549-2705
(770) 297-0401
Mailing address
1679 OLD PENDERGRASS RD, JEFFERSON, GA 30549-2705
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902238926
INDIVIDUAL NPI
—
Enumeration date
01/30/2018
Last updated
01/30/2018
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