| NPI | 1316035207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN A WILSON Office Manager 601-264-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 1453-71) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-08-22 |