| Canton Communitydentalclinicllc | |
|
512 W Fulton St Canton MS 39046-4254 | |
| (601) 855-5885 | |
| (601) 855-2833 |
| Full Name | Canton Communitydentalclinicllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 512 W Fulton St, Canton, Mississippi |
| Authorized Official Name and Position | Timothy Terell Johnson (DENTIST) |
| Authorized Official Contact | 6018555885 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Canton Communitydentalclinicllc 512 W Fulton St Canton MS 39046-4254 Ph: (601) 855-5885 | Canton Communitydentalclinicllc 512 W Fulton St Canton MS 39046-4254 Ph: (601) 855-5885 |
| NPI Number | 1568567477 |
|---|---|
| Provider Enumeration Date | 09/14/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568567477 | NPI | - | NPPES |
| 08324092 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3108-99 (Mississippi) | Primary |
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