| Ellisville State School Dental | |
|
1101 Highway 11 S Ellisville MS 39437-4443 | |
| (601) 477-9384 | |
| (601) 477-5700 |
| Full Name | Ellisville State School Dental |
|---|---|
| Speciality | Dentist |
| Location | 1101 Highway 11 S, Ellisville, Mississippi |
| Authorized Official Name and Position | Suzie Lassiter (DIRECTOR OF FACILITY) |
| Authorized Official Contact | 6014779384 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellisville State School Dental 1101 Highway 11 S Ellisville MS 39437-4443 Ph: (601) 477-9384 | Ellisville State School Dental 1101 Highway 11 S Ellisville MS 39437-4443 Ph: (601) 477-9384 |
| NPI Number | 1013085414 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013085414 | NPI | - | NPPES |
| 09013809 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 09013809 (Mississippi) | Primary |
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 | |
Dental Group Of Ellisville, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 97 Hal Crocker Road, Ellisville, MS 39437 Phone: 601-477-3779 Fax: 601-477-3770 |