Healthcare Provider Details

I. General information

NPI: 1922166610
Provider Name (Legal Business Name): BILL PICKARD, DDS, MS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 N SHILOH DR STE 3
FAYETTEVILLE AR
72703-5317
US

IV. Provider business mailing address

3533 N SHILOH DR STE 3
FAYETTEVILLE AR
72703-5317
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-3411
  • Fax: 479-442-3901
Mailing address:
  • Phone: 479-442-3411
  • Fax: 479-442-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2035
License Number StateAR

VIII. Authorized Official

Name: DR. BILL PICKARD
Title or Position: OWNER,ORTHODONTIST
Credential: DDS, MS, PA
Phone: 479-442-3411