South Delta Dental Clinic, LLC

NPI #1902162811 in Rolling Fork, Mississippi

Provider Information

NPI Number: 1902162811
Entity Type: Organization
Organization Name: South Delta Dental Clinic, LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 4, 2012
Last Updated: Apr 4, 2012

Practice Location

Address: 21 S FOURTH ST
City: Rolling Fork
State: Mississippi
ZIP Code: 39159-5146
Phone: (662) 873-5170

Authorized Official

Name: MR. MICHAEL MURPHY
Title: CHIEF OPERATING OFFICER
Phone: (601) 955-7970

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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