| NPI | 1114414802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTY TOUPS Office Manager 601-271-8710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2018-04-18 |