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General NPI Number Information
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NPI Number | 1689443004
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Entity Type | Organization
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Legal Business Name | NEELY & .LUDWIG PLLC
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 4801 OLD CANTON ROAD
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City | JACKSON
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State | MS
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Zip | 39211
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Country | US
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Telephone | 601-981-7122
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Fax |
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Provider Business Mailing Address
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Address Line | 4801 OLD CANTON ROAD
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City | JACKSON
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State | MS
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Zip | 39211
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Country | US
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Telephone | 601-981-7122
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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. ROBERT J. NEELY
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Credential | DMD
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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 | 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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