| South Main Dental | |
|
209 S Main St Pontotoc MS 38863-3319 | |
| (662) 489-7768 | |
| (662) 489-8256 |
| Full Name | South Main Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 209 S Main St, Pontotoc, Mississippi |
| Authorized Official Name and Position | John Thomas Black (MANAGER) |
| Authorized Official Contact | 6624897768 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Main Dental 209 S Main St Pontotoc MS 38863-3319 Ph: (662) 489-7768 | South Main Dental 209 S Main St Pontotoc MS 38863-3319 Ph: (662) 489-7768 |
| NPI Number | 1043756687 |
|---|---|
| Provider Enumeration Date | 01/06/2017 |
| Last Update Date | 01/06/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043756687 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2066-84 (Mississippi) | Primary |
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