# MADISON PEDIATRIC DENTAL GROUP, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669795241
- **Authorized official:** DR. AMY GRAHAM JONES D.M.D. (OWNER)
- **Authorized official phone:** (601) 856-1511

## Contact information

- **Practice address:** 7728 OLD CANTON RD, SUITE A, MADISON, MS 39110-6103
- **Practice address phone:** (601) 856-1511
- **Practice address fax:** (601) 856-1011
- **Mailing address:** 7728 OLD CANTON RD, SUITE A, MADISON, MS 39110-6103
- **Mailing address phone:** (601) 856-1511
- **Mailing address fax:** (601) 856-1011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | MS | Yes |

## Other

- **Enumeration date:** 03/10/2010
- **Last updated:** 03/10/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 08305709 | — | MS |