Healthcare Provider Details

I. General information

NPI: 1528006186
Provider Name (Legal Business Name): R. E. HAMBUCHEN D.D.S. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CHESTNUT ST
CONWAY AR
72032-5402
US

IV. Provider business mailing address

550 CHESTNUT ST
CONWAY AR
72032-5402
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-8754
  • Fax: 501-329-2530
Mailing address:
  • Phone: 501-329-8754
  • Fax: 501-329-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number167
License Number StateAR

VIII. Authorized Official

Name: DR. R. E. HAMBUCHEN
Title or Position: OWNER
Credential: DDS
Phone: 501-329-8754