Vicksburg Family Dental
NPI #1235497108 in Vicksburg, Mississippi
Provider Information
- NPI Number
- 1235497108
- Entity Type
- Organization
- Organization Name
- Vicksburg Family Dental
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Apr 30, 2012
- Last Updated
- Apr 30, 2012
Practice Location
- Address
- 1212 MISSION 66
- City
- Vicksburg
- State
- Mississippi
- ZIP Code
- 39183
- Phone
- (601) 636-5321
Authorized Official
- Name
- DR. TERRY LAKE GARNER, D.M.D.
- Title
- OWNER/DENTIST
- Phone
- (601) 636-5321
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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