| NPI | 1124209465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARCY REDUS Office Mgr 662-323-9726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS PEDO-006-74) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2007-11-15 |