Organization
BOONEVILLE GENERAL DENTISTRY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL ROBERT HALL DMD (PRES)
(662) 728-2123
Entity
Organization
Contact information
Practice address
507 E CHURCH ST, BOONEVILLE, MS 38829-3709
(662) 728-2123
(662) 728-1748
Mailing address
507 E CHURCH ST, BOONEVILLE, MS 38829-3709
(662) 728-2123
(662) 728-1748
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3645 12
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09234892
—
MS
Enumeration date
05/26/2015
Last updated
05/26/2015
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