Organization
FIRST DENTAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN A WILSON (OFFICE MANAGER)
(601) 264-5100
Entity
Organization
Contact information
Practice address
313 S 40TH AVE, HATTIESBURG, MS 39402-1734
(601) 264-5100
(601) 264-6669
Mailing address
PO BOX 17798, HATTIESBURG, MS 39404-7798
(601) 264-5100
(601) 264-6669
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1453-71
MS
Other
Enumeration date
10/10/2006
Last updated
08/22/2020
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