| NPI | 1386051993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN BRYANT LUCKETT Owner/Member 601-684-3966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MS 2664-92) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2016-08-12 |