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General NPI Number Information
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NPI Number | 1659095495
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Entity Type | Organization
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Legal Business Name | GERMANTOWN FAMILY DENTAL
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 102 DEES DRIVE SUITE M
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 601-381-8200
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Fax | 601-381-8255
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Provider Business Mailing Address
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Address Line | 102 DEES DRIVE SUITE M
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 601-381-8200
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Fax | 601-381-8255
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Authorized Official
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Title or Position | DIRECTOR OF PAYOR CONTRACTS
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Name | MRS. CASEY M CASTLE
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Credential |
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Telephone | 912-732-1504
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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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