| NPI | 1598120842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA BONNER Member 479-899-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 4016) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2015-12-30 |