Organization
LEAF RIVER DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LANTHEA MANGUM (COO)
(601) 271-8710
Entity
Organization
Contact information
Practice address
1115 EVELYN GANDY PARKWAY, PETAL, MS 39465
(601) 271-8710
Mailing address
4358 LINCOLN ROAD EXT STE 20, HATTIESBURG, MS 39402-3275
(601) 271-8710
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/15/2020
Last updated
06/15/2020
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