Organization
DENTAL GROUP OF GREENVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MILLER (CREDENTIALING SPECIALIST)
(601) 271-8710
Entity
Organization
Contact information
Practice address
637 RAYNER RD, GREENVILLE, MS 38701-8135
(662) 378-8606
Mailing address
637 RAYNER RD, GREENVILLE, MS 38701-8135
(662) 378-8606
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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