| NPI | 1699918540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARCUS DEWITT BLACK Dentist 479-464-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 2858) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3664) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2009-04-08 |