| Hattiesburg Orthodontics Pllc | |
|
704 S 28th Ave Suite 20 Hattiesburg MS 39402-2524 | |
| (601) 450-2141 | |
| Not Available |
| Full Name | Hattiesburg Orthodontics Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 704 S 28th Ave, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Tracy Faler Stanley (OWNER) |
| Authorized Official Contact | 6014502141 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hattiesburg Orthodontics Pllc 704 S 28th Ave Suite 20 Hattiesburg MS 39402-2524 Ph: (601) 450-2141 | Hattiesburg Orthodontics Pllc 704 S 28th Ave Suite 20 Hattiesburg MS 39402-2524 Ph: (601) 450-2141 |
| NPI Number | 1083832422 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083832422 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 3110-99 (Mississippi) | Primary |
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