Organization
MAIN STREET DENTAL
Active
Other names
Drs. Joe Braddy & Simmons
Organization subpart
No
Provider details
NPI number
Authorized official
JARAD BRADDY (MEMBER)
(662) 393-0781
Entity
Organization
Contact information
Practice address
8747 NORTHWEST DR, SOUTHAVEN, MS 38671-2409
(662) 393-0781
(662) 342-0750
Mailing address
8747 NORTHWEST DR, SOUTHAVEN, MS 38671-2409
(662) 393-0781
(662) 342-0750
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3341-05
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
082288765
—
MS
Enumeration date
01/10/2013
Last updated
01/28/2016
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