| NPI | 1568854388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN WARD-JONES CEO 870-733-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2020-11-18 |