Individual
CHIANTI WOODFORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6028
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3781-15
MS
Other
Enumeration date
07/02/2014
Last updated
07/05/2015
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