Ollie Hardaway JR. D.D.S.

NPI 1063539138 - Dentist - 1223G0001X

NPI Details
NPI 1063539138
Gender Male
Enumeration Date 03/23/2007
Last Updated 12/17/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
154 COTTONWOOD STREET
VICKSBURG MS, 39180, US
Phone (662) 873-4593
Fax (662) 873-4112
Business Location
113 RIALTO ST
VICKSBURG MS, 39180-6030, US
Phone (601) 636-0834
Fax
Toxanomy
Taxonomy Code 1223G0001X
License State Mississippi
License Number 180178
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According to our database, Dr. Ollie Hardaway JR. D.D.S. NPI is 1063539138, taxonomy code is 1223G0001X and license number is 180178, license state is located at Mississippi. Ollie Hardaway JR. D.D.S. physically located at 154 Cottonwood Street, Vicksburg MS, 39180. NPI Number Ollie Hardaway JR. D.D.S. has the Individual type.

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1063539138 NPI number is provided on an as is basis without warranty of any kind. 1063539138 is maintained by the National Plan & Provider Enumeration System. The contents of Ollie Hardaway JR. D.D.S. are for informational purposes only.