Organization
PERIODONTAL ASSOCIATES OF JACKSON, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER B. PARKES D.M.D. (OWNER/DENTIST)
(601) 956-1230
Entity
Organization
Contact information
Practice address
406 BRIARWOOD DR., STE. 101, JACKSON, MS 39206
(601) 956-1230
(601) 956-0201
Mailing address
406 BRIARWOOD DR., STE. 101, JACKSON, MS 39206
(601) 956-1230
(601) 956-0201
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
1845-79
MS
1223P0300X
Periodontics
2364-87
MS
Other
Enumeration date
10/06/2011
Last updated
10/06/2011
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