Organization
MEDICAL ARTS DENTAL NORTH JACKSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J NEELY DMD (DENTIST/OWNER)
(601) 948-2073
Entity
Organization
Contact information
Practice address
4801 OLD CANTON RD, JACKSON, MS 39211-5522
(601) 948-2073
(601) 354-8773
Mailing address
4801 OLD CANTON RD, JACKSON, MS 39211-5522
(601) 948-2073
(601) 354-8773
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
228886
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04831314
—
MS
Enumeration date
03/14/2012
Last updated
03/14/2012
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