| NPI | 1184727315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY SCOTT ALLEN Owner President 870-935-6516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AR 3047) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2011-11-09 |