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General NPI Number Information
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NPI Number | 1184892184
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Entity Type | Organization
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Legal Business Name | JEFFREY M. NIOLET, D.M.D.
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 300 E RAILROAD ST
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City | LONG BEACH
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State | MS
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Zip | 39560-4722
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Country | US
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Telephone | 228-864-8711
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Fax | 228-864-3765
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Provider Business Mailing Address
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Address Line | 300 E RAILROAD ST
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City | LONG BEACH
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State | MS
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Zip | 39560-4722
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Country | US
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Telephone | 228-864-8711
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Fax | 228-864-3765
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Authorized Official
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Title or Position | FRONT OFFICE
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Name | JOANNIE DAVIS
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Credential |
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Telephone | 228-864-8711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 314400
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License Number State | MS
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