| NPI | 1568626489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATONYA WARE Owner/Operator 662-226-1865 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MS 336906) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2013-09-19 |