Organization
STATE OF MISSISSIPPI - UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
Active
Other names
University Dentists
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY CLARDY (PRACTICE MANAGER)
(601) 984-4699
Entity
Organization
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-4699
(601) 815-6137
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-4699
(601) 815-6137
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009014021
—
MS
Enumeration date
02/09/2007
Last updated
03/03/2025
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