Organization
FOREST DENTAL PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNE S GIBSON (OFFICE ASSISTANT)
(601) 469-3851
Entity
Organization
Contact information
Practice address
1040 HIGHWAY 35 S, FOREST, MS 39074-9423
(601) 469-3851
Mailing address
PO DRAWER 30, FOREST, MS 39074
(601) 469-3851
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1021
MS
1223G0001X
General Practice Dentistry
1853
MS
1223G0001X
General Practice Dentistry
Primary
2182
MS
1223G0001X
General Practice Dentistry
3218
MS
Other
Enumeration date
04/05/2012
Last updated
04/05/2012
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