Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3282-03 | MS |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | OS372-03 | MS |
NPI | 1104927243 |
---|---|
Provider Name | Dr. Harry Vincent Precheur |
First Address | Jackson, MS 39216 |
Second Address | Jackson, MS 39216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 15/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03637857 | (05) | MS |