Organization
GREENVILLE DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EUSTACE H WINN III D.M.D. (OWNER)
(662) 332-9011
Entity
Organization
Contact information
Practice address
1391 E REED RD, GREENVILLE, MS 38703-7234
(662) 332-9011
(662) 332-9012
Mailing address
1391 E REED RD, GREENVILLE, MS 38703-7234
(662) 332-9011
(662) 332-9012
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2893-95
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660177
—
MS
Enumeration date
04/08/2011
Last updated
04/08/2011
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