| NPI | 1770889552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL M HUDGENS Vice President 501-364-1079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3693) |
| 1223G0001X Dentist, General Practice (Licence: AR 3693) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 3693) | |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2018-10-18 |