| NPI | 1982996864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY GARRETT Medicaid / Front Onffice 501-624-7129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 2481) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2011-06-01 |