Organization
G. DODD BRISTER, JR., DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD DODD BRISTER JR. (ORTHODONTIST)
(601) 824-5878
Entity
Organization
Contact information
Practice address
3007 GREENFIELD RD, PEARL, MS 39208-8712
(601) 824-5878
Mailing address
3007 GREENFIELD RD, PEARL, MS 39208-8712
(601) 824-5878
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
OR22292
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660332
—
MS
Enumeration date
11/03/2011
Last updated
11/03/2011
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