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General NPI Number Information
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NPI Number | 1821391202
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Entity Type | Organization
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Legal Business Name | CENTRAL MISSISSIPPI ORAL & MAXIOLLOFACIAL
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 971 LAKELAND DR STE 952
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City | JACKSON
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State | MS
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Zip | 39216-4609
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Country | US
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Telephone | 601-981-3111
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Fax | 601-981-3112
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Provider Business Mailing Address
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Address Line | 971 LAKELAND DR STE 952
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City | JACKSON
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State | MS
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Zip | 39216-4609
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Country | US
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Telephone | 601-981-3111
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Fax | 601-981-3112
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Authorized Official
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Title or Position | DR.
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Name | DR. RODNEY A HUNT
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Credential | D.D.S
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Telephone | 601-981-3111
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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 | 1521
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License Number State | MS
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