# DORMOIS & FUSON, P.L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PEDIATRIC DENTAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639235963
- **Authorized official:** LORI ORFANS C.D.A. (OFFC MGR)
- **Authorized official phone:** (662) 349-3838

## Contact information

- **Practice address:** 7734 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5306
- **Practice address phone:** (662) 349-3838
- **Practice address fax:** (662) 349-5923
- **Mailing address:** 7734 AIRWAYS BLVD, SOUTHAVEN, MS 38671-5306
- **Mailing address phone:** (662) 349-3838
- **Mailing address fax:** (662) 349-5923

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/29/2006
- **Last updated:** 02/23/2012