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General NPI Number Information
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NPI Number | 1659539351
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Entity Type | Organization
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Legal Business Name | MEDICAL ARTS DENTAL GROUP P.A.
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 1151 N STATE ST SUITE 401
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City | JACKSON
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State | MS
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Zip | 39202-2407
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Country | US
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Telephone | 601-948-2073
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Fax | 601-354-8773
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Provider Business Mailing Address
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Address Line | 1151 N STATE ST SUITE 401
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City | JACKSON
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State | MS
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Zip | 39202-2407
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Country | US
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Telephone | 601-948-2073
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Fax | 601-354-8773
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | DR. ROBERT JERRY NEELY
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Credential | D.M.D.
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Telephone | 601-948-2073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 228886
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License Number State | MS
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