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Organization
LAKELAND PERIODONTICS AND IMPLANTS
Active
Organization
LAKELAND PERIODONTICS AND IMPLANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MILLER (CREDENTIALING SPECIALIST)
(601) 271-8710
Entity
Organization
Contact information
Practice address
2550 FLOWOOD DR STE 401, FLOWOOD, MS 39232-9320
(601) 271-8710
(601) 271-6055
Mailing address
2550 FLOWOOD DR STE 401, FLOWOOD, MS 39232-9320
(601) 271-8710
(601) 271-6055
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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