| NPI | 1811648751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN PHILLIPS Practice Manager 479-521-4181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-01-12 |