Individual
DR. CLASTIE DEAN UMFRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
579 E GOODMAN ROAD SUITE #6, SOUTHAVEN, MS 38671-9433
(662) 536-2900
(662) 536-2990
Mailing address
1228 GOODMAN RD E STE 2, SOUTHAVEN, MS 38671-9540
(662) 536-2900
(662) 536-2990
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
3244-02
MS
1223G0001X
General Practice Dentistry
Primary
324402
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173192192
—
MS
05
—
DNT173192192
—
MS
Enumeration date
11/14/2006
Last updated
01/11/2023
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