Healthcare Provider Details

I. General information

NPI: 1508089533
Provider Name (Legal Business Name): STEPHEN AND RACHEL DEAL, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WILSON FARM RD
GREENBRIER AR
72058-9310
US

IV. Provider business mailing address

17 WILSON FARM RD P O BOX 310
GREENBRIER AR
72058-9310
US

V. Phone/Fax

Practice location:
  • Phone: 501-679-4700
  • Fax: 501-679-4777
Mailing address:
  • Phone: 501-679-4700
  • Fax: 501-679-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3441
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3442
License Number StateAR

VIII. Authorized Official

Name: STEPHEN A DEAL
Title or Position: DENTIST
Credential: DDS
Phone: 501-679-4700