| NPI | 1316330681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY STIEVE Regional Medical Director 870-267-6398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 3193) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2015-03-11 |