Healthcare Provider Details

I. General information

NPI: 1134733876
Provider Name (Legal Business Name): BRADLEY R CROSSFIELD DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 EAST CENTERTON BLVD SUITE A
CENTERTON AR
72719
US

IV. Provider business mailing address

PO BOX 677
CENTERTON AR
72719-0677
US

V. Phone/Fax

Practice location:
  • Phone: 501-951-0031
  • Fax:
Mailing address:
  • Phone: 501-951-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY RAY CROSSFIELD
Title or Position: OWNER, MANAGER
Credential: DDS
Phone: 501-951-0031