| NPI | 1922523091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA CUSHMAN Office Manager 479-957-2443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AR 3148) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2017-08-09 |