Organization
MID TOWN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEY GADDIS (OFFICE MANAGER)
(601) 355-5275
Entity
Organization
Contact information
Practice address
808 N STATE ST, SUITE A, JACKSON, MS 39202-2602
(601) 355-5275
Mailing address
808 N STATE ST, JACKSON, MS 39202-2602
(601) 355-5275
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
294096
MS
Other
Enumeration date
02/13/2014
Last updated
02/13/2014
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