Individual
SUSAN LEAKE SHOULTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2910 MELTON AVE, PASCAGOULA, MS 39581-4120
(228) 762-9250
(228) 762-1785
Mailing address
2910 MELTON AVE, PASCAGOULA, MS 39581-4120
(228) 762-9250
(228) 762-1785
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
292396
MS
Other
Enumeration date
03/22/2007
Last updated
07/08/2007
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