Organization
ELLISVILLE FAMILY DENTAL CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN L SURBER DMD (OWNER)
(601) 477-3771
Entity
Organization
Contact information
Practice address
401 HIGHWAY 11 S, ELLISVILLE, MS 39437-3103
(601) 477-3771
Mailing address
401 HIGHWAY 11 S, ELLISVILLE, MS 39437-3103
(601) 477-3771
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2366-87
MS
Other
Enumeration date
01/12/2007
Last updated
08/31/2016
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