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Organization

EDWARDS DENTAL CLINIC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LANE GIBSON CLOWER DMD (DMD)
(601) 852-2832
Entity
Organization

Contact information

Practice address
1202 HWY 22, EDWARDS, MS 39066
(601) 852-2832
(601) 852-8927
Mailing address
1202 HWY 22, EDWARDS, MS 39066
(601) 852-2832
(601) 852-8927

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
253590
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00060458
PROVIDER
MS
05
05730275
MS
Enumeration date
01/29/2007
Last updated
08/22/2020
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