| Bryan B. Martin, Dmd, Llc | |
|
405 N Clark Ave Magnolia MS 39652-2609 | |
| (601) 783-2606 | |
| (601) 783-0572 |
| Full Name | Bryan B. Martin, Dmd, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 405 N Clark Ave, Magnolia, Mississippi |
| Authorized Official Name and Position | Bryan B Martin (DOCTOR/OWNER) |
| Authorized Official Contact | 6017832606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bryan B. Martin, Dmd, Llc 405 N Clark Ave Magnolia MS 39652-2609 Ph: (601) 783-2606 | Bryan B. Martin, Dmd, Llc 405 N Clark Ave Magnolia MS 39652-2609 Ph: (601) 783-2606 |
| NPI Number | 1710278429 |
|---|---|
| Provider Enumeration Date | 04/28/2011 |
| Last Update Date | 04/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710278429 | NPI | - | NPPES |
| 1932300977 | Other | MS | INDIVIDUAL NPI |
| 07575621 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3453.08 (Mississippi) | Primary |
| 1223G0001X | Dentist - General Practice | 22474 (Texas) | Secondary |
Magnolia Family Dental, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 215 Magnolia St, Magnolia, MS 39652 Phone: 601-783-2361 |