Organization
SOUTH DELTA DENTAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL MURPHY (CHIEF OPERATING OFFICER)
(601) 955-7970
Entity
Organization
Contact information
Practice address
21 S FOURTH ST, ROLLING FORK, MS 39159-5146
(662) 873-5170
Mailing address
21 S FOURTH ST, ROLLING FORK, MS 39159-5146
(662) 873-5170
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
360411
MS
Other
Enumeration date
04/04/2012
Last updated
04/04/2012
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