South Main Dental Clinic, LLC

NPI #1043756687 in Pontotoc, Mississippi

Provider Information

NPI Number
1043756687
Entity Type
Organization
Organization Name
South Main Dental Clinic, LLC
Primary Specialty
Dentist - General Practice
Enumeration Date
Jan 6, 2017
Last Updated
Jan 6, 2017

Practice Location

Address
209 S MAIN ST
ZIP Code
38863-3319
Phone
(662) 489-7768

Authorized Official

Name
DR. JOHN THOMAS BLACK JR., D.M.D.
Title
MANAGER
Phone
(662) 489-7768

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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