Organization
LUMBERTON DENTAL CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM HENRY VANN JR. DDS (GENERAL DENTIST PRESIDENT)
(601) 796-8449
Entity
Organization
Contact information
Practice address
7935 US HWY 11, LUMBERTON, MS 39455
(601) 796-8449
(601) 796-9225
Mailing address
PO BOX 431, LUMBERTON, MS 39455
(601) 796-8449
(601) 796-9225
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
173676
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00064465
—
MS
Enumeration date
04/04/2007
Last updated
08/22/2020
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