Organization
SOUTH MAIN DENTAL CLINIC, LLC
Active
Other names
SOUTH MAIN DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN THOMAS BLACK JR. D.M.D. (MANAGER)
(662) 489-7768
Entity
Organization
Contact information
Practice address
209 S MAIN ST, PONTOTOC, MS 38863-3319
(662) 489-7768
(662) 489-8256
Mailing address
209 S MAIN ST, PONTOTOC, MS 38863-3319
(662) 489-7768
(662) 489-8256
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2066-84
MS
Other
Enumeration date
01/06/2017
Last updated
01/06/2017
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