| NPI | 1851886857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVIA K VAN GORDON Dentist 662-226-1757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MS 3934-17) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2018-06-22 |