| NPI | 1184802084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA B. KETCHUM Coder/Insurance Clerk 601-932-3607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MS 2284-86) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2011-08-04 |