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1154401909
FANASY PROKOP JEFCOAT
MADISON, MS
NPI
1154401909
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1223P0300X Dentist, Periodontics
(Licence: MS 3251-03)
Enumeration Date
2006-10-16
Last Update Date
2017-02-07
Business Address
Dr. FANASY PROKOP JEFCOAT D.M.D., MS
101 WEBSTER CIRCLE SUITE 100
MADISON, MS 39110
Phone number: 601-605-6511
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Mailing Address
Dr. FANASY PROKOP JEFCOAT D.M.D., MS
2044 TIDEWATER LN
MADISON, MS 39110-8927
Phone number: 601-605-6511
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