MEDICARE: WEDINGTON COURT DENTAL ASSOCIATES

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	1223G0001X	General Practice Dentistry	2977	AR

General Provider Information

NPI Number	:	1760740799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEDINGTON COURT DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1188 N SALEM RD
Second Line	:	#10
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-8807
Country	:	US
Telephone Number	:	479-527-0707
Fax Number	:	479-527-0201

Provider Business Practice Location Address
First Line	:	1188 N SALEM RD
Second Line	:	#10
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-8807
Country	:	US
Telephone Number	:	479-527-0707
Fax Number	:	479-527-0201

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. GARY G GUTHRIE
Credential	:	DDS
Telephone Number	:	479-527-0707

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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