| NPI | 1568784882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY J LONG President 601-894-4732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 925-59) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2010-03-01 |