| NPI | 1982229985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOLIN EMRYS WEAVER President/ Orthodontist 870-972-5445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2020-06-15 |