| NPI | 1598236796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE TACKEL Office Manager 479-286-0040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |