| Southern Orthodontic Specialists, P.c. | |
|
7732 Airways Blvd Southaven MS 38671-5306 | |
| (662) 349-0777 | |
| (662) 349-0782 |
| Full Name | Southern Orthodontic Specialists, P.c. |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 7732 Airways Blvd, Southaven, Mississippi |
| Authorized Official Name and Position | David R Libby (ORTHODONTIST) |
| Authorized Official Contact | 6623490777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Orthodontic Specialists, P.c. 7732 Airways Blvd Southaven MS 38671-5306 Ph: (662) 349-0777 | Southern Orthodontic Specialists, P.c. 7732 Airways Blvd Southaven MS 38671-5306 Ph: (662) 349-0777 |
| NPI Number | 1801921614 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801921614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 1154-64 (Mississippi) | Primary |
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