| NPI | 1386867414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY G WALKER Office Manager 601-932-8212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 235987) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 192481) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2008-06-18 |