Organization
EPP LOWERY MS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BERTOLLINI (CREDENTIALING MANAGER)
(315) 450-0763
Entity
Organization
Contact information
Practice address
5740 GETWELL RD BLDG 10A, SOUTHAVEN, MS 38672-7360
(662) 890-3196
Mailing address
PO BOX 1584, BRENTWOOD, TN 37024-1584
(315) 450-0763
(615) 422-6719
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Enumeration date
11/06/2024
Last updated
11/06/2024
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