| Poplarville Dental Clinic | |
|
1718 South Main Street Poplarville MS 39470-4287 | |
| (601) 795-8024 | |
| (601) 795-0745 |
| Full Name | Poplarville Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1718 South Main Street, Poplarville, Mississippi |
| Authorized Official Name and Position | Dustin Gabriel Smith (DENTIST) |
| Authorized Official Contact | 6017958024 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Poplarville Dental Clinic 1718 S Main St Mailing P O Box 73 Poplarville MS 39470-4287 Ph: (601) 795-8024 | Poplarville Dental Clinic 1718 South Main Street Poplarville MS 39470-4287 Ph: (601) 795-8024 |
| NPI Number | 1306142674 |
|---|---|
| Provider Enumeration Date | 02/04/2011 |
| Last Update Date | 02/04/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306142674 | NPI | - | NPPES |
| 00660344 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 3142-00 (Mississippi) | Primary |
Poplarville Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1718 S Main St, Poplarville, MS 39470 Phone: 601-795-8024 Fax: 601-795-0745 |