Healthcare Provider Details

I. General information

NPI: 1356561344
Provider Name (Legal Business Name): THOMAS A SARNA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 N GREEN ACRES RD
FAYETTEVILLE AR
72703-2619
US

IV. Provider business mailing address

2025 N GREEN ACRES RD
FAYETTEVILLE AR
72703-2619
US

V. Phone/Fax

Practice location:
  • Phone: 479-202-8666
  • Fax: 844-315-4115
Mailing address:
  • Phone: 479-202-8666
  • Fax: 844-315-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019-027004
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4013
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: