Healthcare Provider Details

I. General information

NPI: 1093837619
Provider Name (Legal Business Name): ROY E DENTON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 ROBINSON AVE
CONWAY AR
72034-4943
US

IV. Provider business mailing address

1138 N GERMANTOWN PKWY # 101-377
CORDOVA TN
38016-5872
US

V. Phone/Fax

Practice location:
  • Phone: 501-932-3500
  • Fax: 501-932-3520
Mailing address:
  • Phone: 901-737-3071
  • Fax: 901-328-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC7072
License Number StateAR

VIII. Authorized Official

Name: NEIDA BYRD
Title or Position: BILLIING MANAGER
Credential:
Phone: 901-737-3071