Healthcare Provider Details

I. General information

NPI: 1790907475
Provider Name (Legal Business Name): WM TREVOR COFFEE DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S ELM ST
HOPE AR
71801-6518
US

IV. Provider business mailing address

901 S ELM ST
HOPE AR
71801-6518
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-2577
  • Fax: 870-777-2587
Mailing address:
  • Phone: 870-777-2577
  • Fax: 870-777-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3432
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3432
License Number StateAR

VIII. Authorized Official

Name: WILLIAM TREVOR COFFEE
Title or Position: PRESIDENT
Credential: DDS
Phone: 870-777-2577