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General NPI Number Information
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NPI Number | 1285817510
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Entity Type | Organization
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Legal Business Name | OAK GROVE FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 6657 U S HIGHWAY 98
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City | HATTIESBURG
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State | MS
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Zip | 39402-8442
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Country | US
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Telephone | 601-264-0537
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Fax | 601-268-7395
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Provider Business Mailing Address
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Address Line | 6657 U S HIGHWAY 98
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City | HATTIESBURG
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State | MS
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Zip | 39402-8442
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Country | US
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Telephone | 601-264-0537
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Fax | 601-268-7395
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ALAN D. LUCAS
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Credential | D.M.D.
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Telephone | 601-264-0537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 249689
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License Number State | MS
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