| NPI | 1568567477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY TERELL JOHNSON Dentist 601-855-5885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 3108-99) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |