| NPI | 1922267657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI MODELEVSKY Office Manager 870-972-8570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: AR 2302) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2012-06-19 |