Organization
CENTER AVENUE DENTAL CARE, LLC
Active
Parent organization
BISHOP & BASS, P.A.
Organization subpart
Yes
Provider details
NPI number
Legal business name
BISHOP & BASS, P.A.
Authorized official
DR. ROGER KYLE BASS D.M.D. (PRESIDENT)
(601) 765-4355
Entity
Organization
Contact information
Practice address
90 CENTER AVE, SUMRALL, MS 39482-5002
(601) 758-3535
(601) 758-9225
Mailing address
90 CENTER AVE, P.O. BOX 217, SUMRALL, MS 39482-5002
(601) 758-3535
(601) 758-9225
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3287
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01751273
—
MS
05
—
02880272
—
MS
Enumeration date
02/23/2009
Last updated
02/23/2009
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