# ORAL PATHOLOGY SERVICES-UMC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** UNIVERSITY DENTISTS, PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1336320795
- **Legal business name:** UNIVERSITY DENTISTS, PLLC
- **Authorized official:** STACY BROOKERD (MANAGER, BUSINESS OPERATIONS)
- **Authorized official phone:** (601) 984-6094

## Contact information

- **Practice address:** 2500 N STATE ST, JACKSON, MS 39216-4500
- **Practice address phone:** (601) 984-6194
- **Practice address fax:** (601) 815-3901
- **Mailing address:** 2500 N STATE ST, JACKSON, MS 39216-4500
- **Mailing address phone:** (601) 984-6194
- **Mailing address fax:** (601) 815-3901

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | — | NULL | Yes |

## Other

- **Enumeration date:** 11/14/2007
- **Last updated:** 01/26/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 09014021 | — | MS |