| NPI | 1417268426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNARD WILLIAM PETKOVICH Dentist 870-425-9757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 2371) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2010-06-24 |