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General NPI Number Information
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NPI Number | 1245613439
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Entity Type | Individual
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Provider Name | JOSEPH-CHARLES MARDINI D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 110 HIGHWAY 61 S
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City | NATCHEZ
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State | MS
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Zip | 39120-5217
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Country | US
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Telephone | 240-477-9551
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Fax |
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Provider Business Mailing Address
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Address Line | 740 BOULEVARD MONTPELLIER APT 1614
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City | MONTREAL
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State | QEUEBC
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Zip | H4L 5B1
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Country | CA
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Telephone | 240-477-9551
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3851-16
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License Number State | MS
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