| NPI | 1992042386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONTGOMERY DWIGHT HEATHMAN President/CEO 479-856-5588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR AR3333) |
| Enumeration Date | 2013-01-06 |
| Last Update Date | 2013-01-06 |