Organization
DECATUR DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM H POLLES DMD PA (OWNER)
(601) 362-1118
Entity
Organization
Contact information
Practice address
68 FOURTH AVE, DECATUR, MS 39327-9713
(601) 635-2340
Mailing address
1836 CRANE RIDGE DR, SUITE A, JACKSON, MS 39216-4901
(601) 362-1118
(601) 362-3113
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3402-06
MS
Other
Enumeration date
10/30/2015
Last updated
10/30/2015
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