| NPI | 1679660492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBY D MADDOX Dentist/Owner 601-782-9206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 1219-66) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-08-22 |