Healthcare Provider Details

I. General information

NPI: 1144242736
Provider Name (Legal Business Name): HOT SPRING VILLAGE DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DENTISTA DR
HOT SPRINGS VILLAGE AR
71909-3503
US

IV. Provider business mailing address

101 DENTISTA DR
HOT SPRINGS VILLAGE AR
71909-3503
US

V. Phone/Fax

Practice location:
  • Phone: 501-922-6700
  • Fax: 501-922-6357
Mailing address:
  • Phone: 501-922-6700
  • Fax: 501-922-6357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2947
License Number StateAR

VIII. Authorized Official

Name: DR. JEFFERY C FUSILIER
Title or Position: PRESIDENT
Credential: DDS
Phone: 501-922-6700