| Main Street Family Dentistry Pa | |
|
627 West Main St Tupelo MS 38804 | |
| (662) 840-0066 | |
| (662) 840-7966 |
| Full Name | Main Street Family Dentistry Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 627 West Main St, Tupelo, Mississippi |
| Authorized Official Name and Position | Brett M Hildenbrand (PRESIDENT) |
| Authorized Official Contact | 6628400066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Family Dentistry Pa 627 West Main St Tupelo MS 38804 Ph: (662) 840-0066 | Main Street Family Dentistry Pa 627 West Main St Tupelo MS 38804 Ph: (662) 840-0066 |
| NPI Number | 1376623074 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 06/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376623074 | NPI | - | NPPES |
| 08823205 | Medicaid | MS | |
| 07158222 | Medicaid | MS | |
| 00660449 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 267792 (Mississippi) | Primary |
| 1223G0001X | Dentist - General Practice | 324002 (Mississippi) | Secondary |
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