| NPI | 1780827543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID J CONNER Owner/President 601-947-4828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 1664-75) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA D2697) |
| 122300000X Dentist (Licence: LA 5712) | |
| 122300000X Dentist (Licence: MS 3392-06) | |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2009-04-09 |