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Organization
MADISON PEDIATRIC DENTAL GROUP, PLLC
Active
Organization
MADISON PEDIATRIC DENTAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY GRAHAM JONES D.M.D. (OWNER)
(601) 856-1511
Entity
Organization
Contact information
Practice address
7728 OLD CANTON RD, SUITE A, MADISON, MS 39110-6103
(601) 856-1511
(601) 856-1011
Mailing address
7728 OLD CANTON RD, SUITE A, MADISON, MS 39110-6103
(601) 856-1511
(601) 856-1011
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08305709
—
MS
Enumeration date
03/10/2010
Last updated
03/10/2010
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