| NPI | 1821137316 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON SCOTT GRISSOM Partner 601-898-9390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3218-02) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3228-02) |
| 1223G0001X Dentist, General Practice (Licence: MS 3260-03) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2020-08-22 |