MEDICARE: DR. PATRICK DRIVER, DDS, PLLC

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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1447712856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. PATRICK DRIVER, DDS, PLLC

Provider Business Mailing Address
First Line	:	201 N 34TH ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-0352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N 34TH ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-0352
Country	:	US
Telephone Number	:	479-631-6074
Fax Number	:

Authorized Official
Title or Position	:	PERIODONTIST
Name	:	DR. PATRICK EDWARD DRIVER
Credential	:	DDS
Telephone Number	:	479-631-6074

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	04/03/2019

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