Organization
JACKSON DENTAL CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRLEY G WALKER (OFFICE MANAGER)
(601) 932-8212
Entity
Organization
Contact information
Practice address
2655 LAKELAND DR, FLOWOOD, MS 39232-9516
(601) 932-8212
(601) 939-8169
Mailing address
2655 LAKELAND DR, FLOWOOD, MS 39232-9516
(601) 932-8212
(601) 939-8169
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
192481
MS
122300000X
Dentist
Primary
235987
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285640383
NPI
MS
01
—
1669488763
NPI
MS
01
—
208026392
TAX ID#
MS
Enumeration date
04/10/2007
Last updated
06/18/2008
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