Organization
ARCHUSA FAMILY DENTISTRY
Active
Parent organization
AGELESS INTENTIONS
Organization subpart
Yes
Provider details
NPI number
Legal business name
AGELESS INTENTIONS
Authorized official
DR. REAGAN DANIELLE MCNERNEY DMD (OWNER)
(601) 927-5961
Entity
Organization
Contact information
Practice address
99 HIGHWAY 511, QUITMAN, MS 39355-8899
(601) 776-3700
Mailing address
99 HIGHWAY 511, QUITMAN, MS 39355-8899
(601) 927-5961
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518564210
—
MS
Enumeration date
04/14/2021
Last updated
07/09/2021
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