| NPI | 1124491733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN M JOHNSON President 501-327-5255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: AR 3775) |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: AR 2606) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2015-11-04 |