Organization
DENTAL PROFESSIONALS OF MISSISSIPPI, P.C.
Active
Parent organization
DENTAL PROFESSIONALS OF MISSISSIPPI, P.C.
Other names
Reservoir Dental Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF MISSISSIPPI, P.C.
Authorized official
KIM WILSON (CRED. SUPERVISOR)
(217) 540-5170
Entity
Organization
Contact information
Practice address
555 GRANTS FERRY RD, BRANDON, MS 39047-9023
(601) 992-1382
Mailing address
555 GRANTS FERRY RD, BRANDON, MS 39047-9023
(601) 992-1382
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/29/2013
Last updated
10/29/2013
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