| NPI | 1649907387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE GARDNER Office Manager 601-638-8230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2022-08-03 |