| NPI | 1043756687 |
|---|---|
| Doing Business As | SOUTH MAIN DENTAL |
| Entity Type | Organization |
| Authorized Contact | JOHN THOMAS BLACK Manager 662-489-7768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2066-84) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2017-01-06 |