Healthcare Provider Details

I. General information

NPI: 1659405132
Provider Name (Legal Business Name): BELLA VISTA HEARING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SUGAR CREEK CENTER
BELLA VISTA AR
72714
US

IV. Provider business mailing address

22 SUGAR CREEK CENTER
BELLA VISTA AR
72714
US

V. Phone/Fax

Practice location:
  • Phone: 479-876-0110
  • Fax: 479-876-0111
Mailing address:
  • Phone: 479-876-0110
  • Fax: 479-876-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA206
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberA206
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MOLLY J DILLON
Title or Position: OWNER
Credential:
Phone: 479-254-0011