| NPI | 1619005972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY BRIAN PRIDE Owner 601-856-6364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MS Endo 23993) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2013-02-07 |