| NPI | 1407107063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENE M BAINES Owner 662-455-3192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS MS1905-80) |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2012-09-24 |