Provider Demographics
NPI:1144735481
Name:PEOPLES DENTAL PA
Entity type:Organization
Organization Name:PEOPLES DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WOOLFOLK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-418-7691
Mailing Address - Street 1:1016 LOUISVILLE ST STE G
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3953
Mailing Address - Country:US
Mailing Address - Phone:662-338-0700
Mailing Address - Fax:662-338-0710
Practice Address - Street 1:1016 LOUISVILLE ST STE G
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3953
Practice Address - Country:US
Practice Address - Phone:662-338-0700
Practice Address - Fax:662-338-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental