| NPI | 1750581906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICKI ASHLEY Office Manager 601-932-0606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 3137) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3138) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2007-07-24 |