| South Jackson Family Dental, Pllc | |
|
5643 Highway 18 W Suite G Jackson MS 39209-9529 | |
| (601) 922-0056 | |
| Not Available |
| Full Name | South Jackson Family Dental, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5643 Highway 18 W, Jackson, Mississippi |
| Authorized Official Name and Position | Lake Garner (OWNER) |
| Authorized Official Contact | 6012718710 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Jackson Family Dental, Pllc Po Box 18560 Hattiesburg MS 39404-8560 Ph: (601) 271-8710 | South Jackson Family Dental, Pllc 5643 Highway 18 W Suite G Jackson MS 39209-9529 Ph: (601) 922-0056 |
| NPI Number | 1821406570 |
|---|---|
| Provider Enumeration Date | 07/25/2014 |
| Last Update Date | 07/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821406570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2940-96MS (Mississippi) | Primary |
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