| NPI | 1043305170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLOVIS ANDY KITCHENS President 501-223-0822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 3186) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 3512) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |