Organization
MADISON PEDIATRIC DENTAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY GRAHAM JONES D.M.D. (OWNER)
(601) 856-1511
Entity
Organization
Contact information
Practice address
7728 OLD CANTON RD, SUITE A, MADISON, MS 39110-6103
(601) 856-1511
(601) 856-1011
Mailing address
7728 OLD CANTON RD, SUITE A, MADISON, MS 39110-6103
(601) 856-1511
(601) 856-1011
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08305709
—
MS
Enumeration date
03/10/2010
Last updated
03/10/2010
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