| NPI | 1679063176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI PAGE Insurance Billing 662-887-1272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MS 273893) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MS 392117) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-06-20 |