Madison Dental Group, Pllc
NPI #1760106199 in Madison, Mississippi
Provider Information
- NPI Number
- 1760106199
- Entity Type
- Organization
- Organization Name
- Madison Dental Group, Pllc
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Sep 29, 2022
- Last Updated
- Sep 29, 2022
Practice Location
- Address
- 7731 OLD CANTON RD STE A
- City
- Madison
- State
- Mississippi
- ZIP Code
- 39110-6115
- Phone
- (601) 853-3565
Authorized Official
- Name
- WILLIAM COLEMAN FORTENBERRY, DMD
- Title
- OWNER
- Phone
- (601) 853-3565
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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