Organization
SCHOOL OF DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY WAYNE REEVES DMD (DEAN OF CLINICAL AFFAIRS)
(601) 984-6155
Entity
Organization
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6155
(601) 815-3901
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6155
(601) 815-3901
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013378
—
MS
Enumeration date
02/15/2007
Last updated
08/22/2020
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