| Back Bay Family Dentistry | |
|
10409 Boney Ave Diberville MS 39540-4813 | |
| (228) 392-0509 | |
| (228) 392-8709 |
| Full Name | Back Bay Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 10409 Boney Ave, Diberville, Mississippi |
| Authorized Official Name and Position | Jeremy W Parker (OWNER) |
| Authorized Official Contact | 2283920509 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Back Bay Family Dentistry 10409 Boney Ave Diberville MS 39540-4813 Ph: (228) 392-0509 | Back Bay Family Dentistry 10409 Boney Ave Diberville MS 39540-4813 Ph: (228) 392-0509 |
| NPI Number | 1316306988 |
|---|---|
| Provider Enumeration Date | 02/11/2016 |
| Last Update Date | 02/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316306988 | NPI | - | NPPES |
| 09424204 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3553-10 (Mississippi) | Primary |
Steven K Miner Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 10409 Boney Ave, Diberville, MS 39540 Phone: 228-424-0145 | |
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