Organization
ORAL PATHOLOGY SERVICES-UMC
Active
Parent organization
UNIVERSITY DENTISTS, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY DENTISTS, PLLC
Authorized official
STACY BROOKERD (MANAGER, BUSINESS OPERATIONS)
(601) 984-6094
Entity
Organization
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6194
(601) 815-3901
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6194
(601) 815-3901
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09014021
—
MS
Enumeration date
11/14/2007
Last updated
01/26/2012
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