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General NPI Number Information
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NPI Number | 1740482306
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Entity Type | Organization
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Legal Business Name | DR. MILTON GARY WALDROP
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 116 LAWRENCE DR SUITE 1
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City | COLUMBUS
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State | MS
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Zip | 39702-5319
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Country | US
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Telephone | 662-328-9123
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Fax | 662-328-9152
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Provider Business Mailing Address
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Address Line | 116 LAWRENCE DR SUITE 1
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City | COLUMBUS
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State | MS
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Zip | 39702-5319
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Country | US
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Telephone | 662-328-9123
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Fax | 662-328-9152
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KRIS BURNSIDE JOURDAN
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Credential |
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Telephone | 662-328-9123
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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 | 1024-61
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License Number State | MS
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