| NPI | 1780764902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD HOLIFIELD Doctor / President 601-577-2723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MS PER-201-87) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2016-04-06 |