Healthcare Provider Details

I. General information

NPI: 1952510356
Provider Name (Legal Business Name): LOWDER & STORMS ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 N MALL AVE STE 101
FAYETTEVILLE AR
72703-4929
US

IV. Provider business mailing address

4102 N MALL AVE STE 101
FAYETTEVILLE AR
72703-4929
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-8887
  • Fax: 479-521-8889
Mailing address:
  • Phone: 479-521-8887
  • Fax: 479-521-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3447
License Number StateAR

VIII. Authorized Official

Name: DR. DARRIN M. STORMS
Title or Position: PRESIDENT
Credential: D.D.S., C.A.G.S., PA
Phone: 479-521-8887