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NPI Code Detail

MEDICARE: GRANTS FERRY FAMILY DENTISTRY

MEDICARE: GRANTS FERRY FAMILY DENTISTRY
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
1261QD0000XDental Clinic/Center3276-03MS

General Provider Information

NPI Number : 1265779052
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANTS FERRY FAMILY DENTISTRY
Provider Business Mailing Address
First Line : 1075 LAKE VILLAGE CIR
Second Line :
City : BRANDON
State : MS
Zip : 39047-6743
Country : US
Telephone Number : 601-992-1605
Fax Number : 601-992-9534
Provider Business Practice Location Address
First Line : 1075 LAKE VILLAGE CIR
Second Line :
City : BRANDON
State : MS
Zip : 39047-6743
Country : US
Telephone Number : 601-992-1605
Fax Number : 601-992-9534
Authorized Official
Title or Position : OWNER
Name : DR. CARLA RUSHING
Credential :
Telephone Number : 601-992-1605
Provider Enumeration Date : 01/14/2013
Last Update Date : 01/14/2013

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Directions to “GRANTS FERRY FAMILY DENTISTRY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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