| NPI | 1750508479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN S CLARK President 228-896-8355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: MS OR-050-82) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2010-09-28 |