| New Augusta Dental | |
|
203 Pine Street West New Augusta MS 39462-0411 | |
| (601) 964-8400 | |
| (601) 964-8400 |
| Full Name | New Augusta Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 203 Pine Street West, New Augusta, Mississippi |
| Authorized Official Name and Position | Leslie Rae Wells (OWNER) |
| Authorized Official Contact | 6019648400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New Augusta Dental Po Box 411 New Augusta MS 39462-0411 Ph: (601) 964-8400 | New Augusta Dental 203 Pine Street West New Augusta MS 39462-0411 Ph: (601) 964-8400 |
| NPI Number | 1225369705 |
|---|---|
| Provider Enumeration Date | 01/22/2010 |
| Last Update Date | 01/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225369705 | NPI | - | NPPES |
| 05838340 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 343207 (Mississippi) | Primary |