| NPI | 1578626966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD G TRAXLER President 601-776-6630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MS 185679) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2017-04-13 |