Provider Demographics
NPI:1356668214
Name:CALHOUN FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:CALHOUN FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-628-5363
Mailing Address - Street 1:PO BOX 1580
Mailing Address - Street 2:
Mailing Address - City:CALHOUN CITY
Mailing Address - State:MS
Mailing Address - Zip Code:38916-1580
Mailing Address - Country:US
Mailing Address - Phone:662-628-5363
Mailing Address - Fax:662-628-1275
Practice Address - Street 1:104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CALHOUN CITY
Practice Address - State:MS
Practice Address - Zip Code:38916-7029
Practice Address - Country:US
Practice Address - Phone:662-628-5363
Practice Address - Fax:662-628-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental