| NPI | 1144618307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLE JEROME JOHNSON Owner/President 479-452-2995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 3867) |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2014-12-22 |