Healthcare Provider Details

I. General information

NPI: 1356668214
Provider Name (Legal Business Name): CALHOUN FAMILY DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N MAIN ST
CALHOUN CITY MS
38916-7029
US

IV. Provider business mailing address

PO BOX 1580
CALHOUN CITY MS
38916-1580
US

V. Phone/Fax

Practice location:
  • Phone: 662-628-5363
  • Fax: 662-628-1275
Mailing address:
  • Phone: 662-628-5363
  • Fax: 662-628-1275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name: DR. JIMMY G DOBBS
Title or Position: MANAGER
Credential: DMD
Phone: 662-628-5363