Organization
VICKSBURG FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY LAKE GARNER D.M.D. (OWNER/DENTIST)
(601) 636-5321
Entity
Organization
Contact information
Practice address
1212 MISSION 66, VICKSBURG, MS 39183
(601) 636-5321
(601) 883-2366
Mailing address
1212 MISSION 66, VICKSBURG, MS 39183-3137
(601) 636-5321
(601) 883-2366
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2940-96MS
MS
Other
Enumeration date
04/30/2012
Last updated
04/30/2012
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