| NPI | 1790907475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM TREVOR COFFEE President 870-777-2577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 3432) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 3432) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2008-07-14 |