Healthcare Provider Details

I. General information

NPI: 1376062257
Provider Name (Legal Business Name): OXFORD FAMILY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2162 S LAMAR BLVD
OXFORD MS
38655-5224
US

IV. Provider business mailing address

4358 LINCOLN ROAD EXT STE 20
HATTIESBURG MS
39402-3275
US

V. Phone/Fax

Practice location:
  • Phone: 662-236-1969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRY LAKE GARNER
Title or Position: OWNER
Credential: DMD
Phone: 601-271-8710