| NPI | 1497112825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA CASKEY Office Manager 601-856-1919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MS 1880-80) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: MS 3551-10) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2016-01-15 |