Healthcare Provider Details

I. General information

NPI: 1508334400
Provider Name (Legal Business Name): SMILE SHOPPE FAYETTEVILLE JEFFREY D. RHODES DDS MS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3484 W WEDINGTON DR
FAYETTEVILLE AR
72704-5730
US

IV. Provider business mailing address

5518 W WALSH LN
ROGERS AR
72758-8947
US

V. Phone/Fax

Practice location:
  • Phone: 479-631-6377
  • Fax:
Mailing address:
  • Phone: 479-631-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KARIE WATSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 479-631-6377