Individual
MONET KALISHA DUCKSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
68 OLD AIRPORT RD, HATTIESBURG, MS 39401-8382
(601) 583-4800
(601) 584-7769
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-3700
(601) 450-2493
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3617-11
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015171
—
MS
01
—
12284817
CAQH ID#
MS
Enumeration date
08/31/2011
Last updated
11/15/2011
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