| NPI | 1952484701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WAYNE RIVES Owner 601-366-7396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MS 1807-78) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-08-22 |