Healthcare Provider Details

I. General information

NPI: 1376780098
Provider Name (Legal Business Name): THE DERMATOLOGY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 DALLAS STREET
FORT SMITH AR
72903-5690
US

IV. Provider business mailing address

7900 DALLAS ST
FORT SMITH AR
72903-5690
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-6647
  • Fax: 479-250-0505
Mailing address:
  • Phone: 479-242-6647
  • Fax: 479-250-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberE-2778
License Number StateAR

VIII. Authorized Official

Name: DR. PHILLIP CRAIG STITES
Title or Position: PRESIDENT
Credential: MD
Phone: 479-242-6647