730 New Albany Professional PLLC
Dentist, General Practice in New Albany, MS. Organization (NPI-2).
NPI number1710691241
StatusActive
Last updated in NPPESJan 10, 2023
Details
- NPI
- 1710691241
- Entity type
- Organization (NPI-2)
- Legal business name
- 730 New Albany Professional PLLC
- Organization subpart
- No
- Enumeration date
- Jan 10, 2023
- Certification date
- Jan 6, 2023
- Last updated
- Jan 10, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Rowan Family Dentistry (Doing Business As)
Practice location
731 Coulter DrNew Albany, MS 38652
Phone 662-534-4397 · Fax 662-534-6599
Mailing address
731 Coulter DrNew Albany, MS 38652
Phone 662-534-4397 · Fax 662-534-6599
Authorized official
Peter Grumbos
Owner
6625344397
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