| Divine Dentistry | |
|
11505 Cinema Dr Suite 6 Diberville MS 39540-9704 | |
| (228) 396-9000 | |
| Not Available |
| Full Name | Divine Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11505 Cinema Dr, Diberville, Mississippi |
| Authorized Official Name and Position | Andrea L Davis (DENTIST/OWNER) |
| Authorized Official Contact | 2288634009 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Dentistry 28 Pass Rd Suite 300 Gulfport MS 39507-3244 Ph: (228) 863-4009 | Divine Dentistry 11505 Cinema Dr Suite 6 Diberville MS 39540-9704 Ph: (228) 396-9000 |
| NPI Number | 1427327725 |
|---|---|
| Provider Enumeration Date | 12/16/2011 |
| Last Update Date | 05/20/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427327725 | NPI | - | NPPES |
| 01524745 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 334905 (Mississippi) | Primary |
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