Organization
QUITMAN FAMILY DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM BROCK MARTIN DMD, JD (DENTIST, PARTNER)
(601) 776-2511
Entity
Organization
Contact information
Practice address
105 E DONALD ST, QUITMAN, MS 39355-2342
(601) 776-2511
(601) 776-8993
Mailing address
PO BOX 2926, MERIDIAN, MS 39302-2926
(601) 776-2511
(601) 776-8993
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1841-79
MS
1223G0001X
General Practice Dentistry
Primary
3396-06
MS
Other
Enumeration date
12/03/2011
Last updated
12/03/2011
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