MEDICARE: DONNA D. MASSEY D.D.S.

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	261QD0000X	Dental Clinic/Center	AR2649	AR

General Provider Information

NPI Number	:	1093979098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONNA D. MASSEY D.D.S.

Provider Business Mailing Address
First Line	:	7215 SHERIDAN RD
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3214
Country	:	US
Telephone Number	:	870-535-4050
Fax Number	:	870-535-2819

Provider Business Practice Location Address
First Line	:	7215 SHERIDAN RD
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3214
Country	:	US
Telephone Number	:	870-535-4050
Fax Number	:	870-535-2819

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DONNA D. MASSEY
Credential	:	DDS
Telephone Number	:	870-535-4050

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	07/18/2008

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