Organization
DENTAL CARE OF MADISON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON SCOTT GRISSOM D.M.D. (PARTNER)
(601) 898-9390
Entity
Organization
Contact information
Practice address
1896 MAIN ST, SUITE B, MADISON, MS 39110-7676
(601) 898-9390
(601) 898-9395
Mailing address
1896 MAIN ST, SUITE B, MADISON, MS 39110-7676
(601) 898-9390
(601) 898-9395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3218-02
MS
1223G0001X
General Practice Dentistry
3228-02
MS
1223G0001X
General Practice Dentistry
3260-03
MS
Other
Enumeration date
02/05/2007
Last updated
08/22/2020
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