Organization
WOODVILLE DENTAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY MENELEY DEVALL DMD (PRESIDENT)
(601) 888-3090
Entity
Organization
Contact information
Practice address
211 HIGHWAY 61 S, WOODVILLE, MS 39669-3586
(601) 888-3090
(601) 888-3095
Mailing address
211 HWY 61 S, WOODVILLE, MS 39669-3586
(601) 888-3090
(601) 888-3095
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
228586
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720276009
INDIVIDUAL NPI NUMBER
MS
Enumeration date
06/07/2011
Last updated
06/07/2011
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