| NPI | 1255634291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN G BURRIS Sole Manager 870-534-2131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 3802) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |