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General NPI Number Information
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NPI Number | 1871706564
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Entity Type | Organization
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Legal Business Name | AFTER HOURS DENTAL CLINIC, II
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 2310 4TH ST, SUITE B
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City | MERIDIAN
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State | MS
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Zip | 39301
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Country | US
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Telephone | 601-693-4878
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Fax | 601-693-4337
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Provider Business Mailing Address
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Address Line | 2310 4TH ST, SUITE B
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City | MERIDIAN
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State | MS
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Zip | 39301
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Country | US
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Telephone | 601-693-4878
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Fax | 601-693-4337
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Authorized Official
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Title or Position | DENTIST
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Name | JACQUELYN MARIE HUNTER-MOORE
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Credential | DDS
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Telephone | 601-693-4878
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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 | 267892D
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License Number State | MS
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Taxonomy #2
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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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