| NPI | 1528280880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUNDI B. LITTLE Office Manager 662-842-5080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MS 1782-77) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: MS 2554-90) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |