| NPI | 1174044952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN C FISHER Sole Mbr 479-518-5111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2021-02-12 |