Organization
VICKSBURG FAMILY DENTAL 61N
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY LAKE GARNER DMD (OWNER)
(601) 629-6066
Entity
Organization
Contact information
Practice address
1650 HIGHWAY 61 N, VICKSBURG, MS 39183-3522
(601) 629-6066
Mailing address
1650 HIGHWAY 61 N, VICKSBURG, MS 39183-3522
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
MS
Other
Enumeration date
05/10/2016
Last updated
05/10/2016
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