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General NPI Number Information
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NPI Number | 1235441353
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Entity Type | Organization
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Legal Business Name | LAKELAND DENTAL CARE PA
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 11 LAKELAND CIR
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City | JACKSON
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State | MS
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Zip | 39216-5006
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Country | US
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Telephone | 601-981-8166
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Fax | 601-362-2164
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Provider Business Mailing Address
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Address Line | 11 LAKELAND CIR
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City | JACKSON
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State | MS
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Zip | 39216-5006
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Country | US
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Telephone | 601-981-8166
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Fax | 601-362-2164
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEX ABERNATHY
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Credential | DDS
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Telephone | 601-981-8166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1792-78
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License Number State | MS
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