| Dental Group Of Ellisville, Pllc | |
|
97 Hal Crocker Road Ellisville MS 39437 | |
| (601) 477-3779 | |
| (601) 477-3770 |
| Full Name | Dental Group Of Ellisville, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 97 Hal Crocker Road, Ellisville, Mississippi |
| Authorized Official Name and Position | Terry Lake Garner (OWNER) |
| Authorized Official Contact | 6012718710 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Group Of Ellisville, Pllc 97 Hal Crocker Road Ellisville MS 39437 Ph: (601) 477-3779 | Dental Group Of Ellisville, Pllc 97 Hal Crocker Road Ellisville MS 39437 Ph: (601) 477-3779 |
| NPI Number | 1972851814 |
|---|---|
| Provider Enumeration Date | 08/27/2012 |
| Last Update Date | 03/18/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972851814 | NPI | - | NPPES |
| 00660377 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2940-96 (Mississippi) | Primary |
Ellisville State School Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1101 Highway 11 S, Ellisville, MS 39437 Phone: 601-477-9384 Fax: 601-477-5700 | |
Ellisville Family Dental Center Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 401 Highway 11 S, Ellisville, MS 39437 Phone: 601-477-3771 | |
Lloyd B. Wolfe, Jr., D.m.d. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 92 Hal Crocker Rd, Ellisville, MS 39437 Phone: 601-261-0105 Fax: 601-800-8064 |