Organization
GLUCKSTADT FAMILY DENTISTRY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT JEREMIAH HAUPTMAN D.M.D. (OWNER)
(601) 790-9245
Entity
Organization
Contact information
Practice address
1716 HIGHWAY 51 STE G, MADISON, MS 39110-5020
(601) 790-9245
(601) 790-9236
Mailing address
1716 HIGHWAY 51 STE G, MADISON, MS 39110-5020
(601) 790-9245
(601) 790-9236
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3581-11
MS
Other
Enumeration date
11/06/2012
Last updated
11/06/2012
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