| NPI | 1366806820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE VANBENSCHOTEN Manager 870-834-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: LA 3676) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2016-04-11 |