Organization
TERRACE HILL DENTAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHA WALLACE (OFFICE MANAGER)
(601) 264-5756
Entity
Organization
Contact information
Practice address
1126 EVELYN GANDY PARKWAY, PETAL, MS 39465-3947
(601) 264-5756
(601) 264-6200
Mailing address
1126 EVELYN GANDY PARKWAY, PETAL, MS 39465-3947
(601) 264-5756
(601) 264-6200
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1771-77
MS
1223G0001X
General Practice Dentistry
Primary
3353-05
MS
1223G0001X
General Practice Dentistry
3411-07
MS
Other
Enumeration date
07/08/2013
Last updated
07/08/2013
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