Organization
HERITAGE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MILLER (CREDENTIALING SPECIALIST)
(601) 271-8710
Entity
Organization
Contact information
Practice address
303 S ARCHUSA AVE # A, QUITMAN, MS 39355-2325
(601) 776-6630
Mailing address
303 S ARCHUSA AVE # A, QUITMAN, MS 39355-2325
(601) 776-6630
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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