Healthcare Provider Details

I. General information

NPI: 1184838138
Provider Name (Legal Business Name): GEORGE BIRCHAM MORLEDGE III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 OFFICE PARK DRIVE SUITE 104
LITTLE ROCK AR
72211-3865
US

IV. Provider business mailing address

5 OFFICE PARK DRIVE SUITE 104
LITTLE ROCK AR
72211-3865
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-8520
  • Fax: 501-224-1432
Mailing address:
  • Phone: 501-225-8520
  • Fax: 501-224-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2089
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: