Individual
JERRY DEANE TANKERSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
800 OHIO AVE, CLARKSDALE, MS 38614-7200
(662) 624-4292
(662) 627-3629
Mailing address
510 HIGHWAY 322, CLARKSDALE, MS 38614-4717
(662) 624-2504
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2300-86
MS
Other
Enumeration date
05/14/2009
Last updated
06/30/2009
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