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General NPI Number Information
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NPI Number | 1265685606
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Entity Type | Organization
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Legal Business Name | ASSOCIATED DENTAL OF RIDGELAND, PLLC
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 733 LAKE HARBOUR DR STE G
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City | RIDGELAND
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State | MS
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Zip | 39157-4304
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Country | US
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Telephone | 601-856-4888
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Fax | 601-856-8077
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Provider Business Mailing Address
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Address Line | 733 LAKE HARBOUR DR STE G
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City | RIDGELAND
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State | MS
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Zip | 39157-4304
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Country | US
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Telephone | 601-856-4888
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Fax | 601-856-8077
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TERESA MARIE TRUSTY
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Credential |
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Telephone | 601-919-8575
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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 | 3214
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License Number State | MS
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