Healthcare Provider Details

I. General information

NPI: 1295994333
Provider Name (Legal Business Name): WARREN C. MASSEY, DDS, MS. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3089 E MISSION BLVD
FAYETTEVILLE AR
72703-4385
US

IV. Provider business mailing address

3089 E MISSION BLVD
FAYETTEVILLE AR
72703-4385
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-6995
  • Fax: 479-443-6468
Mailing address:
  • Phone: 479-442-6995
  • Fax: 479-443-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2059
License Number StateAR

VIII. Authorized Official

Name: DR. WARREN C MASSEY
Title or Position: DENTIST
Credential: DDS, MS, PA
Phone: 479-442-6995