| NPI | 1902456247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY PRISCILLA GREEN Pediatric Dentist 601-497-2550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2019-09-18 |