| NPI | 1265825004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI LYNN JOHNSTON Office Manager 479-968-8338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 3422) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 2643) |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2016-02-17 |