| NPI | 1104151265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CHANDLER HUMPHREYS Owner 601-794-8115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3329-05) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2009-10-07 |