| NPI | 1831576644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL PARKER President 228-769-9010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 333605) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 375014) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2015-04-30 |