| NPI | 1073688131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI LYNN JOHNSTON Office Manager 479-968-8338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 513) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-08-22 |