Organization
COLLINSVILLE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BROCK MARTIN (DENTIST/OWNER)
(601) 482-5701
Entity
Organization
Contact information
Practice address
9171 A, OLD HWY 19N, COLLINSVILLE, MS 39325
(601) 626-7555
Mailing address
PO BOX 459, COLLINSVILLE, MS 39325-0459
(601) 626-7555
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3396-06
MS
Other
Enumeration date
10/26/2010
Last updated
10/26/2010
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