| NPI | 1962366021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAVANNAH LYNN GIRARD Insurance Coordinator 228-355-2965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-12-12 |
| Last Update Date | 2025-12-12 |