Organization
COMMUNITY DENTAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMAAL EDWIN LONGINO D.M.D. (DENTIST/PRESIDENT)
(601) 825-2150
Entity
Organization
Contact information
Practice address
908 MUNICIPAL DR, BRANDON, MS 39042-2973
(601) 825-2150
(601) 825-2792
Mailing address
908 MUNICIPAL DR, BRANDON, MS 39042-2973
(601) 825-2150
(601) 825-2792
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3483-08
MS
Other
Enumeration date
03/22/2011
Last updated
03/22/2011
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