Organization
SENATOBIA FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAMANTHA RENEE ERVIN (OFFICE MANAGER)
(662) 562-9484
Entity
Organization
Contact information
Practice address
102 N ROBINSON ST, SENATOBIA, MS 38668-2149
(662) 562-9484
(662) 301-8222
Mailing address
102 N ROBINSON ST, SENATOBIA, MS 38668-2149
(662) 562-9484
(662) 301-8222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00060223
—
MS
05
—
00834891
—
MS
Enumeration date
04/08/2021
Last updated
04/08/2021
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