| Polk Dental Center | |
|
120 Scarbrough St Suite B Richland MS 39218-9770 | |
| (601) 932-0606 | |
| (601) 932-0703 |
| Full Name | Polk Dental Center |
|---|---|
| Speciality | Dentist |
| Location | 120 Scarbrough St, Richland, Mississippi |
| Authorized Official Name and Position | Nicki Ashley (OFFICE MANAGER) |
| Authorized Official Contact | 6019320606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Polk Dental Center Po Box 180607 Richland MS 39218-0607 Ph: (601) 932-0606 | Polk Dental Center 120 Scarbrough St Suite B Richland MS 39218-9770 Ph: (601) 932-0606 |
| NPI Number | 1750581906 |
|---|---|
| Provider Enumeration Date | 07/24/2007 |
| Last Update Date | 07/24/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750581906 | NPI | - | NPPES |
| 09016079 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3137 (Mississippi) | Primary |
| 122300000X | Dentist | 3138 (Mississippi) | Secondary |
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