| NPI | 1134341407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY TODD NICHOLS Owner 662-713-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MS 2882-95) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |