| NPI | 1659586287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LANG Treasurer 601-656-7410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2736-93) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2012-06-05 |