| NPI | 1366797953 |
|---|---|
| Doing Business As | DOING BUSINESS AS |
| Entity Type | Organization |
| Authorized Contact | MISTI ROSS Ins Director 870-336-3732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2020-10-14 |