| NPI | 1356606511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY WILKERSON ELLIS Pediatric Dentist 601-482-8986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2012-07-12 |