| NPI | 1861816670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEY GADDIS Office Manager 601-355-5275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 294096) |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2014-02-13 |