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General NPI Number Information
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NPI Number | 1356049126
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Entity Type | Organization
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Legal Business Name | SARDIS FAMILY DENTAL CARE, LLC
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 207 S POCAHONTAS STREET
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City | SARDIS
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State | MS
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Zip | 38666
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Country | US
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Telephone | 601-790-1709
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Fax |
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Provider Business Mailing Address
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Address Line | 207 S POCAHONTAS STREET
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City | SARDIS
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State | MS
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Zip | 38666
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Country | US
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Telephone | 601-790-1709
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SAMANTHA L ALLEN
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Credential | DMD
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Telephone | 601-790-1709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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