| Raleigh Dental Clinic | |
|
207 Sylvarena Ave Raleigh MS 39153 | |
| (601) 782-9206 | |
| Not Available |
| Full Name | Raleigh Dental Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 207 Sylvarena Ave, Raleigh, Mississippi |
| Authorized Official Name and Position | Bobby D Maddox (DENTIST/OWNER) |
| Authorized Official Contact | 6017829206 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Raleigh Dental Clinic Po Box 595 Raleigh MS 39153-0595 Ph: (601) 782-9206 | Raleigh Dental Clinic 207 Sylvarena Ave Raleigh MS 39153 Ph: (601) 782-9206 |
| NPI Number | 1679660492 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679660492 | NPI | - | NPPES |
| 09015677 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1219-66 (Mississippi) | Primary |
Tullos Family Dentistry, Pa Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 276 Magnolia Dr, Raleigh, MS 39153 Phone: 601-782-9909 Fax: 601-782-9133 |