Healthcare Provider Details

I. General information

NPI: 1871917625
Provider Name (Legal Business Name): PHILIP S. MORTON FAMILY DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 PIRATES WAY
CEDARVILLE AR
72932
US

IV. Provider business mailing address

617 FAYETTEVILLE RD
VAN BUREN AR
72956-3418
US

V. Phone/Fax

Practice location:
  • Phone: 479-922-6153
  • Fax:
Mailing address:
  • Phone: 479-474-9696
  • Fax: 479-474-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3370
License Number StateAR

VIII. Authorized Official

Name: KERRY A MORTON
Title or Position: OWNER
Credential:
Phone: 479-474-9696