Organization
AUTUMN RIDGE DENTAL PARTNERSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD Q WEAVER D.M.D. (PARTNER)
(662) 289-7076
Entity
Organization
Contact information
Practice address
101 RIDGEWOOD CIR, KOSCIUSKO, MS 39090-3265
(662) 289-7076
(662) 289-7050
Mailing address
101 RIDGEWOOD CIR, KOSCIUSKO, MS 39090-3265
(662) 289-7076
(662) 289-7050
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1686-75
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014559
—
MS
Enumeration date
04/19/2007
Last updated
01/03/2011
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