Healthcare Provider Details

I. General information

NPI: 1982958450
Provider Name (Legal Business Name): PR8ZEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MCAULEY CT
HOT SPRINGS AR
71913-6312
US

IV. Provider business mailing address

200 MCAULEY CT
HOT SPRINGS AR
71913-6312
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-9200
  • Fax: 501-623-9204
Mailing address:
  • Phone: 501-623-4485
  • Fax: 501-623-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3759
License Number StateAR

VIII. Authorized Official

Name: DARON C PRAETZEL
Title or Position: OWNER
Credential: DMD
Phone: 50162344858