| NPI | 1215205331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM BROCK MARTIN Dentist, Partner 601-776-2511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 3396-06) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 1841-79) |
| Enumeration Date | 2011-12-03 |
| Last Update Date | 2011-12-03 |