| NPI | 1760627301 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE TACKEL Treatment Coordinator 479-636-2990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AR 3384) |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2008-12-11 |