Individual
DR. ALAN L EZELL I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
59 FRONTAGE RD N, MACON, MS 39341
(662) 726-4344
(228) 474-1348
Mailing address
PO BOX 306, MACON, MS 39341
(228) 474-1314
(228) 474-1348
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
233787
MS
1223G0001X
General Practice Dentistry
Primary
233787
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00060342
—
MS
Enumeration date
10/14/2006
Last updated
06/27/2022
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