| NPI | 1427456144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KINYATTA SHAUNTEL BENNETT Manager 228-697-3010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 356410) |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2014-12-11 |