| NPI | 1962422402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ADAM WEEMS Owner 662-453-6243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 3107-99) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-08-22 |