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General NPI Number Information
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NPI Number | 1548817133
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Entity Type | Organization
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Legal Business Name | AIRPARK FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 1060 HOLLAND AVENUE
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City | PHILADELPHIA
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State | MS
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Zip | 39350
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Country | US
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Telephone | 601-656-3275
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Fax | 601-656-3231
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Provider Business Mailing Address
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Address Line | 10120 DOGWOOD LN
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City | PHILADELPHIA
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State | MS
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Zip | 39350-9617
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Country | US
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Telephone | 601-656-3275
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Fax | 601-656-3231
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JENNIFER L STEELE
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Credential |
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Telephone | 601-656-3275
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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 |
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License Number State |
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