Healthcare Provider Details

I. General information

NPI: 1871711457
Provider Name (Legal Business Name): WILLIAM E FOOTE, IV, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S CHERRY ST
HAMBURG AR
71646-3205
US

IV. Provider business mailing address

201 S CHERRY ST
HAMBURG AR
71646-3205
US

V. Phone/Fax

Practice location:
  • Phone: 870-853-4486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3255
License Number StateAR

VIII. Authorized Official

Name: DR. WILLIAM E FOOTE IV
Title or Position: DENTIST
Credential:
Phone: 870-853-4486