| NPI | 1023107240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY J. PACE Insurance COO Rdinator 662-234-5222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 2825-94) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 1700-75) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2008-10-30 |