| NPI | 1669521472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MICHAEL WISE President 501-268-8634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: AR 2687) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-08-22 |