| Magnolia Family Dental Care | |
|
207 W Jackson St Ste B Ridgeland MS 39157-2355 | |
| (601) 707-5585 | |
| (601) 707-5586 |
| Full Name | Magnolia Family Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 207 W Jackson St Ste B, Ridgeland, Mississippi |
| Authorized Official Name and Position | Casey Brian Heitzmann (DENTIST) |
| Authorized Official Contact | 6017075585 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Magnolia Family Dental Care 207 W Jackson St Ste B Ridgeland MS 39157-2355 Ph: (601) 707-5585 | Magnolia Family Dental Care 207 W Jackson St Ste B Ridgeland MS 39157-2355 Ph: (601) 707-5585 |
| NPI Number | 1275836447 |
|---|---|
| Provider Enumeration Date | 12/09/2010 |
| Last Update Date | 12/09/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275836447 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 355510 (Mississippi) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 349108 (Mississippi) | Secondary |
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