| NPI | 1972851814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY LAKE GARNER Owner 601-271-8710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2940-96) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2019-03-18 |