MEDICARE: PEOPLES DENTAL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1144735481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEOPLES DENTAL PA

Provider Business Mailing Address
First Line	:	1016 LOUISVILLE ST STE G
Second Line	:
City	:	STARKVILLE
State	:	MS
Zip	:	39759-3953
Country	:	US
Telephone Number	:	662-338-0700
Fax Number	:	662-338-0710

Provider Business Practice Location Address
First Line	:	1016 LOUISVILLE ST STE G
Second Line	:
City	:	STARKVILLE
State	:	MS
Zip	:	39759-3953
Country	:	US
Telephone Number	:	662-338-0700
Fax Number	:	662-338-0710

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JONATHAN ALLEN WOOLFOLK
Credential	:	DMD
Telephone Number	:	662-418-7691

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	12/08/2017

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Directions to “PEOPLES DENTAL PA ” Practice Location

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