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General NPI Number Information
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NPI Number | 1740642834
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Entity Type | Organization
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Legal Business Name | 1ST DENTAL, LLC
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 313 S 40TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39402-1734
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Country | US
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Telephone | 601-264-5100
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Fax | 601-264-6669
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Provider Business Mailing Address
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Address Line | 313 S 40TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39402-1734
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Country | US
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Telephone | 601-264-5100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH J DAHO
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Credential | DDS
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Telephone | 601-264-5100
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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 |
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License Number State | MS
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