Individual
SANDY THAO TRIEU GASKILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-2158
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
PEDO-6048-23
MS
Other
Enumeration date
04/02/2021
Last updated
10/17/2023
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