Organization
HERNANDO DENTAL GROUP INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY R WADSWORTH DDS (PARTNER)
(662) 429-6736
Entity
Organization
Contact information
Practice address
2264 MCINGVALE RD., HERNANDO, MS 38632
(662) 429-6736
(662) 429-6752
Mailing address
2264 MCINGVALE RD, HERNANDO, MS 38632
(662) 429-6736
(662) 429-6752
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3018-97
MS
Other
Enumeration date
01/30/2013
Last updated
01/30/2013
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