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NPI Code Detail

MEDICARE: VICKI DENISE GANN

MEDICARE: VICKI DENISE GANN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2722-93MS

General Provider Information

NPI Number : 1568679348
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKI DENISE GANN
Provider Business Mailing Address
First Line : 3025 CORDER DR
Second Line :
City : CORINTH
State : MS
Zip : 38834-6216
Country : US
Telephone Number : 662-286-3217
Fax Number : 662-286-3282
Provider Business Practice Location Address
First Line : 3025 CORDER DR
Second Line :
City : CORINTH
State : MS
Zip : 38834-6216
Country : US
Telephone Number : 662-286-3217
Fax Number : 662-286-3282
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2007
Last Update Date : 07/08/2007

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Directions to “ VICKI DENISE GANN ” Practice Location

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