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General NPI Number Information
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NPI Number | 1508958133
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Entity Type | Organization
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Legal Business Name | MID SOUTH DENTAL CENTER OF JACKSON
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5685 HWY 18 WEST
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City | JACKSON
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State | MS
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Zip | 39209
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Country | US
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Telephone | 601-373-2404
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Fax | 601-373-4443
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Provider Business Mailing Address
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Address Line | 5685 HWY 18 WEST
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City | JACKSON
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State | MS
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Zip | 39209
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Country | US
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Telephone | 601-373-2404
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Fax | 601-373-4443
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Authorized Official
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Title or Position | V.PRESIDENT/ DENTIST PARTNERSHIP
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Name | BARINDER SINGH
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Credential | BDS
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Telephone | 601-373-2404
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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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