| Reservoir Dental Group | |
|
555 Grants Ferry Rd Brandon MS 39047-9023 | |
| (601) 992-1382 | |
| Not Available |
| Full Name | Reservoir Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 555 Grants Ferry Rd, Brandon, Mississippi |
| Authorized Official Name and Position | Kim Wilson (CRED. SUPERVISOR) |
| Authorized Official Contact | 2175405170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Reservoir Dental Group 555 Grants Ferry Rd Brandon MS 39047-9023 Ph: (601) 992-1382 | Reservoir Dental Group 555 Grants Ferry Rd Brandon MS 39047-9023 Ph: (601) 992-1382 |
| NPI Number | 1538597653 |
|---|---|
| Provider Enumeration Date | 10/29/2013 |
| Last Update Date | 10/29/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538597653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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