| NPI | 1093927220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK P DEVEREUX Owner And Orthodontist 601-799-3120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 2971) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2013-02-28 |