| NPI | 1245539808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMAAL EDWIN LONGINO Dentist/President 601-825-2150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 3483-08) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2011-03-22 |