| South Delta Dental Clinic, Llc | |
|
21 S Fourth St Rolling Fork MS 39159-5146 | |
| (662) 873-5170 | |
| Not Available |
| Full Name | South Delta Dental Clinic, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 21 S Fourth St, Rolling Fork, Mississippi |
| Authorized Official Name and Position | Michael Murphy (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 6019557970 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Delta Dental Clinic, Llc 21 S Fourth St Rolling Fork MS 39159-5146 Ph: (662) 873-5170 | South Delta Dental Clinic, Llc 21 S Fourth St Rolling Fork MS 39159-5146 Ph: (662) 873-5170 |
| NPI Number | 1902162811 |
|---|---|
| Provider Enumeration Date | 04/04/2012 |
| Last Update Date | 04/04/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902162811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 360411 (Mississippi) | Primary |