| NPI | 1760106199 |
|---|---|
| Other Name | MADISON DENTAL GROUP |
| Doing Business As | MADISON DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | WILLIAM COLEMAN FORTENBERRY Owner 601-853-3565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2022-09-29 |