| NPI | 1780985978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN CUPAN Practice Administrator 501-225-1577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 2268) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 3966) | |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2012-03-21 |