| NPI | 1235497108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY LAKE GARNER Owner/Dentist 601-636-5321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 2940-96MS) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2012-04-30 |