| Madison Pediatric Dental Group, Pllc | |
|
7728 Old Canton Rd Suite A Madison MS 39110-6103 | |
| (601) 856-1511 | |
| (601) 856-1011 |
| Full Name | Madison Pediatric Dental Group, Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 7728 Old Canton Rd, Madison, Mississippi |
| Authorized Official Name and Position | Amy Graham Jones (OWNER) |
| Authorized Official Contact | 6018561511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Pediatric Dental Group, Pllc 7728 Old Canton Rd Suite A Madison MS 39110-6103 Ph: (601) 856-1511 | Madison Pediatric Dental Group, Pllc 7728 Old Canton Rd Suite A Madison MS 39110-6103 Ph: (601) 856-1511 |
| NPI Number | 1669795241 |
|---|---|
| Provider Enumeration Date | 03/10/2010 |
| Last Update Date | 03/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669795241 | NPI | - | NPPES |
| 08305709 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (Mississippi) | Primary |
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