Organization
SOUTH JACKSON FAMILY DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAKE GARNER DMD (OWNER)
(601) 271-8710
Entity
Organization
Contact information
Practice address
5643 HIGHWAY 18 W, SUITE G, JACKSON, MS 39209-9529
(601) 922-0056
Mailing address
PO BOX 18560, HATTIESBURG, MS 39404-8560
(601) 271-8710
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2940-96MS
MS
Other
Enumeration date
07/25/2014
Last updated
07/25/2014
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