| NPI | 1578719399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINGER PAYNE Office 662-226-6014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 1896-80) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MS 1912-80) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2008-08-12 |