Organization
MAIN STREET FAMILY DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRETT M HILDENBRAND DMD (PRESIDENT)
(662) 840-0066
Entity
Organization
Contact information
Practice address
627 WEST MAIN ST, TUPELO, MS 38804
(662) 840-0066
(662) 840-7966
Mailing address
627 WEST MAIN ST, TUPELO, MS 38804
(662) 840-0066
(662) 840-7966
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
267792
MS
1223G0001X
General Practice Dentistry
324002
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660449
—
MS
05
—
07158222
—
MS
05
—
08823205
—
MS
Enumeration date
10/17/2006
Last updated
06/02/2015
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