Healthcare Provider Details

I. General information

NPI: 1487829420
Provider Name (Legal Business Name): JOSHUA L LEAL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N PINE ST
HARRISON AR
72601-3442
US

IV. Provider business mailing address

PO BOX 4185
FAYETTEVILLE AR
72702-4185
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-3877
  • Fax: 870-741-2406
Mailing address:
  • Phone: 870-741-3877
  • Fax: 870-741-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN18572
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019.026579
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3396
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number3396
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: