| NPI | 1538218664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED I WALTERS Dentist 601-649-3335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 171176) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2022-07-21 |