Organization
POLK DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICKI ASHLEY (OFFICE MANAGER)
(601) 932-0606
Entity
Organization
Contact information
Practice address
120 SCARBROUGH ST, SUITE B, RICHLAND, MS 39218-9770
(601) 932-0606
(601) 932-0703
Mailing address
PO BOX 180607, RICHLAND, MS 39218-0607
(601) 932-0606
(601) 932-0703
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3137
MS
122300000X
Dentist
3138
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016079
—
MS
Enumeration date
07/24/2007
Last updated
07/24/2007
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