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General NPI Number Information
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NPI Number | 1780764902
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Entity Type | Organization
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Legal Business Name | BRAD HOLIFIELD, D.M.D., P.A.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 3221 AUDUBON DR
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City | LAUREL
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State | MS
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Zip | 39440-1422
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Country | US
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Telephone | 601-649-3900
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Fax | 601-518-7860
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Provider Business Mailing Address
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Address Line | 3221 AUDUBON DR
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City | LAUREL
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State | MS
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Zip | 39440-1422
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Country | US
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Telephone | 601-649-3900
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Fax | 601-518-7860
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Authorized Official
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Title or Position | DOCTOR / PRESIDENT
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Name | DR. BRAD HOLIFIELD
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Credential | D.M.D.
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Telephone | 601-577-2723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | PER-201-87
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License Number State | MS
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