| NPI | 1366718470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HILARY CRADDOCK Owner 601-932-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3326-05) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3389) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2012-03-23 |