| NPI | 1831104793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN LYNN COSTELLO Office Manager 662-842-8200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: MS MS162174) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2020-08-22 |