Organization
FAMILY DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODI PAGE (INSURANCE BILLING)
(662) 887-1272
Entity
Organization
Contact information
Practice address
501 PARK AVE, INDIANOLA, MS 38751
(662) 887-1272
Mailing address
PO BOX 972, INDIANOLA, MS 38751-0972
(662) 887-1272
(662) 887-6453
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
273893
MS
261QD0000X
Dental Clinic/Center
392117
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660041
—
MS
05
—
07535056
—
MS
01
—
1417048182
NPI
—
01
—
1477073278
NPI
—
Enumeration date
05/10/2018
Last updated
06/20/2018
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