| NPI | 1063630341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN M. VANN Office Manager 501-982-7547 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: AR 2008) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2011-08-11 |