Provider Demographics
NPI:1124193354
Name:CHRISTINA L. DIAL, D.O. PLLC
Entity Type:Organization
Organization Name:CHRISTINA L. DIAL, D.O. PLLC
Other - Org Name:BREAST CARE CLINIC OF JACKSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:601-936-8999
Mailing Address - Street 1:PO BOX 321391
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-1391
Mailing Address - Country:US
Mailing Address - Phone:601-936-8999
Mailing Address - Fax:601-936-0088
Practice Address - Street 1:1044 N FLOWOOD DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9789
Practice Address - Country:US
Practice Address - Phone:601-936-8999
Practice Address - Fax:601-936-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC03149Medicare ID - Type Unspecified