Mississippi Band of Choctaw Indians

NPI #1073715579 in Choctaw, Mississippi

Provider Information

NPI Number: 1073715579
Entity Type: Organization
Organization Name: Mississippi Band of Choctaw Indians
Subpart: Yes (part of a larger organization)
Parent Organization: MISSISSIPPI BAND OF CHOCTAW INDIANS
Primary Specialty: Dentist
Enumeration Date: Jun 5, 2007
Last Updated: Jun 15, 2012

Practice Location

Address: 210 HOSPITAL CIR
City: Choctaw
State: Mississippi
ZIP Code: 39350-6781
Phone: (601) 389-6342

Authorized Official

Name: MRS. PHYLLIS J ANDERSON
Title: TRIBAL CHIEF
Phone: (601) 656-5251

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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