| NPI | 1942762273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN LEE Office Manager 870-897-9465 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2020-12-22 |