Organization
LD-MADISON, LLC
Active
Other names
Colony Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LIZZ DAIGNEAULT BA, MA (ADMIN DIRECTOR)
(256) 783-9468
Entity
Organization
Contact information
Practice address
306 FOUNTAINS DR, MADISON, MS 39110-6384
(601) 605-1410
(601) 605-1367
Mailing address
306 FOUNTAINS DR, MADISON, MS 39110-6384
(601) 605-1410
(601) 605-1367
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/05/2023
Last updated
11/15/2023
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