Healthcare Provider Details

I. General information

NPI: 1922559483
Provider Name (Legal Business Name): REESE LUNSFORD DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 W MAIN ST
ASHDOWN AR
71822-2750
US

IV. Provider business mailing address

370 W MAIN ST
ASHDOWN AR
71822-2750
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-5077
  • Fax: 870-898-2070
Mailing address:
  • Phone: 870-898-5077
  • Fax: 870-898-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4062
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number4062
License Number StateAR

VIII. Authorized Official

Name: DR. WILLIAM REESE LUNSFORD JR.
Title or Position: OWNER
Credential: D.D.S.
Phone: 870-898-5077