| NPI | 1083832422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY FALER STANLEY Owner 601-450-2141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 3110-99) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |