Healthcare Provider Details

I. General information

NPI: 1487728432
Provider Name (Legal Business Name): PAULA J. MARTIN-FLETCHER D.D.S., P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BRECKENRIDGE DR STE B
LITTLE ROCK AR
72227-4864
US

IV. Provider business mailing address

1415 BRECKENRIDGE DR STE B
LITTLE ROCK AR
72227-4864
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-6453
  • Fax: 501-227-6551
Mailing address:
  • Phone: 501-227-6453
  • Fax: 501-227-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3087
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: