| NPI | 1629562616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES TRISTAN RAY HUDSON Owner 479-871-4313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 4275) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 7052) |
| 122300000X Dentist (Licence: MO 2018018775) | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2018-06-21 |