| Advance Dental Clinic | |
|
1555 E County Line Rd Jackson MS 39211-1801 | |
| (601) 206-1112 | |
| (601) 206-1114 |
| Full Name | Advance Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 1555 E County Line Rd, Jackson, Mississippi |
| Authorized Official Name and Position | Denessa V. Toombs (OWNER/MANAGER) |
| Authorized Official Contact | 6012061112 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advance Dental Clinic 1555 E County Line Rd Jackson MS 39211-1801 Ph: (601) 206-1112 | Advance Dental Clinic 1555 E County Line Rd Jackson MS 39211-1801 Ph: (601) 206-1112 |
| NPI Number | 1073708913 |
|---|---|
| Provider Enumeration Date | 09/13/2007 |
| Last Update Date | 09/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073708913 | NPI | - | NPPES |
| 02674220 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3314-04 (Mississippi) | Primary |
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