| NPI | 1598110652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY R BRIDGES Office Manager 479-521-4822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 2180) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2016-04-26 |