Individual
JOHN B SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1040 HWY 35 SOUTH, FOREST, MS 39074
(601) 469-3851
(601) 469-4356
Mailing address
P O DRAWER 30, FOREST, MS 39074
(601) 469-3851
(601) 469-4356
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1853
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00064776
—
MS
Enumeration date
01/12/2007
Last updated
07/09/2007
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