Organization
POPLARVILLE DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUSTIN GABRIEL SMITH DMD (DENTIST)
(601) 795-8024
Entity
Organization
Contact information
Practice address
1718 SOUTH MAIN STREET, POPLARVILLE, MS 39470-4287
(601) 795-8024
(601) 795-0745
Mailing address
1718 S MAIN ST, MAILING P O BOX 73, POPLARVILLE, MS 39470-4287
(601) 795-8024
(601) 795-0745
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3142-00
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660344
—
MS
Enumeration date
02/04/2011
Last updated
02/04/2011
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