Organization
FARESE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEA M FARESE D.M.D. (DENTIST)
(662) 234-8463
Entity
Organization
Contact information
Practice address
2212 JACKSON AVE W, OXFORD, MS 38655-5409
(662) 234-8463
Mailing address
522 WEDGEWOOD, OXFORD, MS 38655-5409
(662) 315-5834
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
3231-02
MS
1223G0001X
General Practice Dentistry
Primary
3293-04
MS
Other
Enumeration date
05/02/2007
Last updated
08/22/2020
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