| NPI | 1194866418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED MCDONALD President 870-536-6430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AR 1983) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2020-08-22 |