| NPI | 1376656041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS W. TILLERY Owner 601-428-6093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS MS133268) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2008-01-03 |