| NPI | 1366986556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REAGAN BRYANT Asst. Business Manager 601-264-5756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 1771-77) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3353-05) |
| 1223G0001X Dentist, General Practice (Licence: MS 3417-07) | |
| 1223G0001X Dentist, General Practice (Licence: MS 3747-14) | |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2017-09-18 |