| NPI | 1710119136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERI COLLAZO Business Manager 501-221-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 2749) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2009-08-18 |