Organization
GADDIS FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREA R GADDIS DDS (OWNER)
(601) 693-7913
Entity
Organization
Contact information
Practice address
1316 25TH AVE LOWR LEVEL, MERIDIAN, MS 39301-3916
(601) 693-7913
(601) 483-2217
Mailing address
1460 SUMMER SEAT RD, VICKSBURG, MS 39183-9270
(601) 693-7913
(601) 483-2217
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3155-00
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015862
—
MS
Enumeration date
12/28/2006
Last updated
08/22/2020
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