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General NPI Number Information
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NPI Number | 1083295844
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Entity Type | Organization
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Legal Business Name | ARCHUSA FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 99 HIGHWAY 511
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City | QUITMAN
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State | MS
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Zip | 39355-8899
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Country | US
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Telephone | 601-776-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 99 HIGHWAY 511
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City | QUITMAN
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State | MS
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Zip | 39355-8899
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Country | US
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Telephone | 601-927-5961
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. REAGAN DANIELLE MCNERNEY
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Credential | DMD
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Telephone | 601-927-5961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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