Organization
RALEIGH DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BOBBY D MADDOX DDS (DENTIST/OWNER)
(601) 782-9206
Entity
Organization
Contact information
Practice address
207 SYLVARENA AVE, RALEIGH, MS 39153
(601) 782-9206
Mailing address
PO BOX 595, RALEIGH, MS 39153-0595
(601) 782-9206
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1219-66
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015677
—
MS
Enumeration date
10/05/2006
Last updated
08/22/2020
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