| NPI | 1215139464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | W. JIM MOORE Owner 870-536-2650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: AR 2165) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-08-22 |