Provider Demographics
NPI:1588833057
Name:GERMANY DENTAL CLINIC
Entity Type:Organization
Organization Name:GERMANY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:GERMANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-824-2280
Mailing Address - Street 1:2004 COURTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3212
Mailing Address - Country:US
Mailing Address - Phone:601-824-2280
Mailing Address - Fax:
Practice Address - Street 1:2004 COURTSIDE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-3212
Practice Address - Country:US
Practice Address - Phone:601-824-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3269-031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty