| NPI | 1952417040 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILLY JOE GRAHAM Owner/Dentist 479-474-2701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AR 152) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 1930) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |