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General NPI Number Information
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NPI Number | 1427190750
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Entity Type | Individual
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Provider Name | STEPHEN R GANDY DMD
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 971 LAKELAND DRIVE SUITE 225
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City | JACKSON
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State | MS
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Zip | 39216-4643
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Country | US
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Telephone | 601-366-7324
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Fax | 601-366-0228
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Provider Business Mailing Address
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Address Line | 971 LAKELAND DRIVE SUITE 225
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City | JACKSON
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State | MS
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Zip | 39216-4643
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Country | US
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Telephone | 601-366-7324
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Fax | 601-366-0228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 240988
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License Number State | MS
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