| Capital Dental Inc | |
|
1771 Lelia Dr Jackson MS 39216-4820 | |
| (601) 362-2660 | |
| (601) 362-6363 |
| Full Name | Capital Dental Inc |
|---|---|
| Speciality | Dentist |
| Location | 1771 Lelia Dr, Jackson, Mississippi |
| Authorized Official Name and Position | M Lewis Grubbs (OWNER/DENTIST) |
| Authorized Official Contact | 6013622660 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capital Dental Inc 1771 Lelia Dr Jackson MS 39216-4820 Ph: (601) 362-2660 | Capital Dental Inc 1771 Lelia Dr Jackson MS 39216-4820 Ph: (601) 362-2660 |
| NPI Number | 1437667060 |
|---|---|
| Provider Enumeration Date | 01/17/2018 |
| Last Update Date | 01/17/2018 |
| Medicare PECOS PAC ID | 7012250061 |
|---|---|
| Medicare Enrollment ID | O20190515002027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437667060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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