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General NPI Number Information
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NPI Number | 1639235963
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Entity Type | Organization
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Legal Business Name | DORMOIS & FUSON, P.L.L.C.
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 7734 AIRWAYS BLVD
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5306
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Country | US
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Telephone | 662-349-3838
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Fax | 662-349-5923
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Provider Business Mailing Address
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Address Line | 7734 AIRWAYS BLVD
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5306
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Country | US
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Telephone | 662-349-3838
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Fax | 662-349-5923
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Authorized Official
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Title or Position | OFFC MGR
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Name | LORI ORFANS
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Credential | C.D.A.
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Telephone | 662-349-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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