Healthcare Provider Details

I. General information

NPI: 1841461274
Provider Name (Legal Business Name): ARKANSAS ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 PRINCE ST SUITE 2
CONWAY AR
72034-3746
US

IV. Provider business mailing address

2425 PRINCE ST SUITE 2
CONWAY AR
72034-3746
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-3223
  • Fax: 501-329-8939
Mailing address:
  • Phone: 501-329-3223
  • Fax: 501-329-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number65
License Number StateAR

VIII. Authorized Official

Name: DR. DONNY L QUICK
Title or Position: ORAL SURGEON
Credential: D.D.S.
Phone: 501-329-3223