Back Bay Family Dentistry
NPI #1316306988 in Diberville, Mississippi
Provider Information
- NPI Number
- 1316306988
- Entity Type
- Organization
- Organization Name
- Back Bay Family Dentistry
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Feb 11, 2016
- Last Updated
- Feb 11, 2016
Practice Location
- Address
- 10409 BONEY AVE
- City
- Diberville
- State
- Mississippi
- ZIP Code
- 39540-4813
- Phone
- (228) 392-0509
Authorized Official
- Name
- JEREMY W PARKER, D.M.D.
- Title
- OWNER
- Phone
- (228) 392-0509
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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