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Individual

DARRELL REX LIVINGSTON JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(662) 379-0033
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3802-15
MS

Other

Enumeration date
07/07/2015
Last updated
07/07/2015
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