| Autumn Ridge Dental Partnership | |
|
101 Ridgewood Cir Kosciusko MS 39090-3265 | |
| (662) 289-7076 | |
| (662) 289-7050 |
| Full Name | Autumn Ridge Dental Partnership |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 101 Ridgewood Cir, Kosciusko, Mississippi |
| Authorized Official Name and Position | Donald Q Weaver (PARTNER) |
| Authorized Official Contact | 6622897076 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Autumn Ridge Dental Partnership 101 Ridgewood Cir Kosciusko MS 39090-3265 Ph: (662) 289-7076 | Autumn Ridge Dental Partnership 101 Ridgewood Cir Kosciusko MS 39090-3265 Ph: (662) 289-7076 |
| NPI Number | 1275750531 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 01/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275750531 | NPI | - | NPPES |
| 09014559 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1686-75 (Mississippi) | Primary |
James D. Neaves Dds Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 207 N Huntington St, Kosciusko, MS 39090 Phone: 662-289-2771 Fax: 662-289-2771 |