| NPI | 1003138967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN BEAVERS Owner / Dentist 601-856-5313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS PEDO 377-04) |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2021-10-19 |