Individual
DR. JACOB KEITH FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
301 HOSPITAL RD, STARKVILLE, MS 39759-2155
(662) 323-3245
Mailing address
10630 ROAD 573, PHILADELPHIA, MS 39350-8304
(601) 781-7474
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
111164
MS
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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