Organization
VICKSBURG ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAKE GARNER (OWNER)
(601) 271-8710
Entity
Organization
Contact information
Practice address
1909A MISSION 66, VICKSBURG, MS 39180-3711
(601) 271-8710
Mailing address
25 SHEARS RD, HATTIESBURG, MS 39402-8849
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2940-96
MS
Other
Enumeration date
09/30/2014
Last updated
09/30/2014
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