| NPI | 1063820215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACLYN WHITE Credentialing Manager 479-717-1047 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AR 3242) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2014-07-31 |