| NPI | 1548612930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE VANBENSCHOTEN Manager 870-834-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5591) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2016-07-08 |