| NPI | 1053525642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON ERIC TIMMONS Orthodontist 870-535-5616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AR 3430) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |