| NPI | 1740482306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRIS BURNSIDE JOURDAN Office Manager 662-328-9123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 1024-61) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2008-07-01 |