Healthcare Provider Details

I. General information

NPI: 1508988585
Provider Name (Legal Business Name): PHELAN ORTHODONTICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 RAHLING RD STE 101
LITTLE ROCK AR
72223-4777
US

IV. Provider business mailing address

1801 RAHLING RD STE 101
LITTLE ROCK AR
72223-4777
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-6535
  • Fax:
Mailing address:
  • Phone: 501-224-6535
  • Fax: 501-224-8652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD T PHELAN
Title or Position: OWNER
Credential: DDS, MS
Phone: 501-224-6535