MEDICARE: CALHOUN FAMILY DENTISTRY PLLC

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		MS

General Provider Information

NPI Number	:	1356668214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALHOUN FAMILY DENTISTRY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1580
Second Line	:
City	:	CALHOUN CITY
State	:	MS
Zip	:	38916-1580
Country	:	US
Telephone Number	:	662-628-5363
Fax Number	:	662-628-1275

Provider Business Practice Location Address
First Line	:	104 N MAIN ST
Second Line	:
City	:	CALHOUN CITY
State	:	MS
Zip	:	38916-7029
Country	:	US
Telephone Number	:	662-628-5363
Fax Number	:	662-628-1275

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. JIMMY G DOBBS
Credential	:	DMD
Telephone Number	:	662-628-5363

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	04/30/2010

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