Organization
GOODMAN ROAD DENTAL PLLC
Active
Other names
Goodman Road Dental PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAX S. BREAZEAL DDS (OWNER)
(901) 861-0031
Entity
Organization
Contact information
Practice address
7271 GOODMAN RD, OLIVE BRANCH, MS 38654-1906
(662) 895-4737
(662) 893-3239
Mailing address
7271 GOODMAN RD, OLIVE BRANCH, MS 38654-1906
(662) 895-4737
(662) 893-3239
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
06/03/2019
Last updated
06/03/2019
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