| NPI | 1619370012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAKE GARNER Owner 601-271-8710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MS 2940-96) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-09-30 |