| Goodloe Dental, P.a. | |
|
1207 W Peace St Canton MS 39046-9037 | |
| (601) 859-9595 | |
| (601) 859-9395 |
| Full Name | Goodloe Dental, P.a. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1207 W Peace St, Canton, Mississippi |
| Authorized Official Name and Position | Erika Goodloe (PRESIDENT) |
| Authorized Official Contact | 6018599595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Goodloe Dental, P.a. Po Box 449 Canton MS 39046-0449 Ph: (601) 859-9595 | Goodloe Dental, P.a. 1207 W Peace St Canton MS 39046-9037 Ph: (601) 859-9595 |
| NPI Number | 1073892576 |
|---|---|
| Provider Enumeration Date | 08/15/2011 |
| Last Update Date | 08/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073892576 | NPI | - | NPPES |
| 00660220 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2942-96 (Mississippi) | Primary |
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