| NPI | 1710278429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN B MARTIN Doctor/Owner 601-783-2606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3453.08) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 22474) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2011-04-28 |