MEDICARE: NORTHWEST ARKANSAS PEDIATRIC DENTAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	2924	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033155411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST ARKANSAS PEDIATRIC DENTAL CENTER

Provider Business Mailing Address
First Line	:	5518 WALSH LN
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8947
Country	:	US
Telephone Number	:	479-631-6377
Fax Number	:	479-273-5967

Provider Business Practice Location Address
First Line	:	5518 WALSH LN
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8947
Country	:	US
Telephone Number	:	479-631-6377
Fax Number	:	479-273-5967

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY D RHODES
Credential	:
Telephone Number	:	479-631-6377

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	01/19/2016

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