Organization
OLIVE BRANCH DENTAL GROUP PLLC
Active
Other names
Goodman Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE K SHIELDS (BUSINESS OFFICE)
(662) 840-1535
Entity
Organization
Contact information
Practice address
7271 GOODMAN RD, OLIVE BRANCH, MS 38654-1906
(662) 895-4737
Mailing address
7271 GOODMAN RD, OLIVE BRANCH, MS 38654-1906
(662) 895-4737
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
233887
MS
Other
Enumeration date
09/28/2016
Last updated
09/28/2016
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