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General NPI Number Information
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NPI Number | 1326265679
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Entity Type | Organization
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Legal Business Name | COMMUNITY DENTAL CARE,PA
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 165 W SOUTH ST
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City | HERNANDO
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State | MS
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Zip | 38632-2269
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Country | US
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Telephone | 662-449-3994
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Fax |
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Provider Business Mailing Address
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Address Line | 165 W SOUTH ST
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City | HERNANDO
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State | MS
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Zip | 38632-2269
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Country | US
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Telephone | 662-449-3994
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. SHIRLEY S SEYMOUR
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Credential |
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Telephone | 662-449-3994
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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 | 1821-78
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License Number State | MS
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