| Collinsville Family Dental | |
|
9171 A Old Hwy 19n Collinsville MS 39325 | |
| (601) 626-7555 | |
| Not Available |
| Full Name | Collinsville Family Dental |
|---|---|
| Speciality | Dentist |
| Location | 9171 A, Collinsville, Mississippi |
| Authorized Official Name and Position | Brock Martin (DENTIST/OWNER) |
| Authorized Official Contact | 6014825701 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Collinsville Family Dental Po Box 459 Collinsville MS 39325-0459 Ph: (601) 626-7555 | Collinsville Family Dental 9171 A Old Hwy 19n Collinsville MS 39325 Ph: (601) 626-7555 |
| NPI Number | 1770883688 |
|---|---|
| Provider Enumeration Date | 10/26/2010 |
| Last Update Date | 10/26/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770883688 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3396-06 (Mississippi) | Primary |