Provider Demographics
NPI:1720390693
Name:METRO DENTAL INC
Entity Type:Organization
Organization Name:METRO DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLES
Authorized Official - Suffix:
Authorized Official - Credentials:MP PA
Authorized Official - Phone:601-862-2752
Mailing Address - Street 1:1836 CRANE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4901
Mailing Address - Country:US
Mailing Address - Phone:601-862-2752
Mailing Address - Fax:
Practice Address - Street 1:1836 CRANE RIDGE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4901
Practice Address - Country:US
Practice Address - Phone:601-862-2752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty