| NPI | 1508114067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN CUPAN Practice Administrator 501-225-1577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 3396) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2012-08-15 |