Main Street Dental

NPI #1043557085 in Southaven, Mississippi

Provider Information

NPI Number: 1043557085
Entity Type: Organization
Organization Name: Main Street Dental
Primary Specialty: Dentist
Enumeration Date: Jan 10, 2013
Last Updated: Jan 28, 2016

Practice Location

Address: 8747 NORTHWEST DR
City: Southaven
State: Mississippi
ZIP Code: 38671-2409
Phone: (662) 393-0781

Authorized Official

Name: JARAD BRADDY
Title: MEMBER
Phone: (662) 393-0781

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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