| NPI | 1275836447 |
|---|---|
| Doing Business As | MAGNOLIA FAMILY DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | CASEY BRIAN HEITZMANN Dentist 601-707-5585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 355510) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 349108) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2010-12-09 |