| Broadwater Dental | |
|
2318 Pass Rd Ste 9 Biloxi MS 39531-4044 | |
| (228) 388-3353 | |
| (228) 388-4696 |
| Full Name | Broadwater Dental |
|---|---|
| Speciality | Dentist |
| Location | 2318 Pass Rd, Biloxi, Mississippi |
| Authorized Official Name and Position | Clifford J Cook (DENTIST) |
| Authorized Official Contact | 2283883353 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Broadwater Dental 2318 Pass Road Ste 9 Biloxi MS 39531 Ph: (228) 388-3353 | Broadwater Dental 2318 Pass Rd Ste 9 Biloxi MS 39531-4044 Ph: (228) 388-3353 |
| NPI Number | 1386186278 |
|---|---|
| Provider Enumeration Date | 11/09/2016 |
| Last Update Date | 11/09/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386186278 | NPI | - | NPPES |
| 01754550 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | MS3497-09 (Mississippi) | Primary |
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