| NPI | 1164842159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER BOND SOUTHARD Dentist 870-932-0702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: AR 3469) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2023-12-04 |