| Madison Dental Group, Pllc | |
|
7731 Old Canton Rd Ste A Madison MS 39110-6115 | |
| (601) 853-3565 | |
| (601) 853-3598 |
| Full Name | Madison Dental Group, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7731 Old Canton Rd Ste A, Madison, Mississippi |
| Authorized Official Name and Position | William Coleman Fortenberry (OWNER) |
| Authorized Official Contact | 6018533565 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Dental Group, Pllc Po Box 1547 Madison MS 39130-1547 Ph: (601) 853-3565 | Madison Dental Group, Pllc 7731 Old Canton Rd Ste A Madison MS 39110-6115 Ph: (601) 853-3565 |
| NPI Number | 1760106199 |
|---|---|
| Provider Enumeration Date | 09/29/2022 |
| Last Update Date | 09/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760106199 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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