Organization
APCEW PA
Active
Other names
Whitlock Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA R WHITLOCK (BOOKKEEPER)
(601) 982-7636
Entity
Organization
Contact information
Practice address
514G E WOODROW WILSON AVE, JACKSON, MS 39216-4538
(601) 982-7636
(601) 982-4536
Mailing address
514 G EAST WOODROW WILSON, JACKSON, MS 39216-4538
(601) 982-7636
(601) 982-4536
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07631537
—
MS
Enumeration date
09/18/2007
Last updated
09/18/2007
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