Leaf River Dental, Pllc
NPI #1750906707 in Petal, Mississippi
Provider Information
- NPI Number
- 1750906707
- Entity Type
- Organization
- Organization Name
- Leaf River Dental, Pllc
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Jun 15, 2020
- Last Updated
- Jun 15, 2020
Practice Location
- Address
- 1115 EVELYN GANDY PARKWAY
- City
- Petal
- State
- Mississippi
- ZIP Code
- 39465
- Phone
- (601) 271-8710
Authorized Official
- Name
- MRS. LANTHEA MANGUM
- Title
- COO
- Phone
- (601) 271-8710
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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