| Center Avenue Dental Care, Llc | |
|
90 Center Ave Sumrall MS 39482-5002 | |
| (601) 758-3535 | |
| (601) 758-9225 |
| Full Name | Center Avenue Dental Care, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 90 Center Ave, Sumrall, Mississippi |
| Authorized Official Name and Position | Roger Kyle Bass (PRESIDENT) |
| Authorized Official Contact | 6017654355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center Avenue Dental Care, Llc 90 Center Ave P.o. Box 217 Sumrall MS 39482-5002 Ph: (601) 758-3535 | Center Avenue Dental Care, Llc 90 Center Ave Sumrall MS 39482-5002 Ph: (601) 758-3535 |
| NPI Number | 1710127311 |
|---|---|
| Provider Enumeration Date | 02/23/2009 |
| Last Update Date | 02/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710127311 | NPI | - | NPPES |
| 02880272 | Medicaid | MS | |
| 01751273 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3287 (Mississippi) | Primary |
Brett Alan Valentine D.m.d. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4864-b Hwy 589, Sumrall, MS 39482 Phone: 601-758-0150 Fax: 601-758-0149 |