Organization
MADISON DENTAL GROUP, PLLC
Active
Other names
Madison Dental Group, Madison Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM COLEMAN FORTENBERRY DMD (OWNER)
(601) 853-3565
Entity
Organization
Contact information
Practice address
7731 OLD CANTON RD STE A, MADISON, MS 39110-6115
(601) 853-3565
(601) 853-3598
Mailing address
PO BOX 1547, MADISON, MS 39130-1547
(601) 853-3565
(601) 853-3598
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/29/2022
Last updated
09/29/2022
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