| Decatur Dental, Llc | |
|
68 Fourth Ave Decatur MS 39327-9713 | |
| (601) 635-2340 | |
| Not Available |
| Full Name | Decatur Dental, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 68 Fourth Ave, Decatur, Mississippi |
| Authorized Official Name and Position | Jim H Polles (OWNER) |
| Authorized Official Contact | 6013621118 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Decatur Dental, Llc 1836 Crane Ridge Dr Suite A Jackson MS 39216-4901 Ph: (601) 362-1118 | Decatur Dental, Llc 68 Fourth Ave Decatur MS 39327-9713 Ph: (601) 635-2340 |
| NPI Number | 1073985925 |
|---|---|
| Provider Enumeration Date | 10/30/2015 |
| Last Update Date | 10/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073985925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 3402-06 (Mississippi) | Primary |