| NPI | 1265685606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA MARIE TRUSTY Office Manager 601-919-8575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3214) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2008-10-29 |