| NPI | 1043533623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNIE J. RICHARDSON Owner/CEO 662-328-8001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3463-08) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 1860-79) |
| 1223G0001X Dentist, General Practice (Licence: MS 3160-00) | |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-03-10 |