| NPI | 1801921614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID R LIBBY Orthodontist 662-349-0777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MS 1154-64) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |