| Park Place Dental Iuka | |
|
915 Battleground Dr Iuka MS 38852-1320 | |
| (662) 660-7142 | |
| (662) 660-7145 |
| Full Name | Park Place Dental Iuka |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 915 Battleground Dr, Iuka, Mississippi |
| Authorized Official Name and Position | Gerry Bowen Green (PARTNER) |
| Authorized Official Contact | 6626607142 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Place Dental Iuka 915 Battleground Dr Iuka MS 38852-1320 Ph: (662) 660-7142 | Park Place Dental Iuka 915 Battleground Dr Iuka MS 38852-1320 Ph: (662) 660-7142 |
| NPI Number | 1982848446 |
|---|---|
| Provider Enumeration Date | 04/28/2009 |
| Last Update Date | 04/28/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982848446 | NPI | - | NPPES |
| 03253066 | Medicaid | MS | |
| 00064011 | Medicaid | MS | |
| 05973097 | Medicaid | MS | |
| 01234014 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 3373-06 (Mississippi) | Primary |
Iuka Family Dental, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 915 Battleground Dr, Iuka, MS 38852 Phone: 662-424-0307 Fax: 662-660-7145 |