Advance Dental Clinic

NPI 1073708913 - Dentist - 122300000X

NPI Details
NPI 1073708913
Enumeration Date 09/13/2007
Last Updated 09/13/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name DENESSA V. DENESSA
Position OWNER/MANAGER
Phone (601) 206-1112
Fax (601) 206-1114
Practice Location
1555 E COUNTY LINE RD
JACKSON MS, 39211-1801, US
Phone (601) 206-1112
Fax (601) 206-1114
Business Location
1555 E COUNTY LINE RD
JACKSON MS, 39211-1801, US
Phone (601) 206-1112
Fax (601) 206-1114
Toxanomy
Taxonomy Code 122300000X
License State Mississippi
License Number 3314-04
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According to our database, Advance Dental Clinic NPI is 1073708913, taxonomy code is 122300000X and license number is 3314-04, license state is located at Mississippi. Advance Dental Clinic physically located at 1555 E County Line Rd, Jackson MS, 39211-1801. NPI Number 1033115704 has the healthcare provider type.

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1073708913 NPI number is provided on an as is basis without warranty of any kind. 1073708913 is maintained by the National Plan & Provider Enumeration System. The contents of Advance Dental Clinic are for informational purposes only.