Individual
BRANNON MYRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 N. STATE ST, DEPARTMENT OF ORAL-MAXILLOFACIAL SURGERY AND PATHOLOGY, JACKSON, MS 39216-4505
(601) 984-6090
Mailing address
2500 N. STATE ST, DEPARTMENT OF ORAL-MAXILLOFACIAL SURGERY AND PATHOLOGY, JACKSON, MS 39216-4505
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10273
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2016
Last updated
10/02/2023
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