| NPI | 1205392263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH LEE CLARK Orthodontist 318-455-1121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2023-03-02 |