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General NPI Number Information
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NPI Number | 1225325731
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Entity Type | Organization
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Legal Business Name | TATUM ORTHODONTICS LLC
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 825 N MAIN ST
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City | HARRISON
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State | AR
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Zip | 72601-2914
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Country | US
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Telephone | 870-204-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 823 N MAIN ST STE 6
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City | HARRISON
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State | AR
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Zip | 72601-2914
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Country | US
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Telephone | 870-204-6555
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. ANNAKATE MILBURN TATUM
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Credential | DDS
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Telephone | 870-204-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 125
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License Number State | AR
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