Healthcare Provider Details

I. General information

NPI: 1275582801
Provider Name (Legal Business Name): STEPHEN W. BOATRIGHT DDS, FAGD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 CANTRELL RD SUITE 1
LITTLE ROCK AR
72223-1705
US

IV. Provider business mailing address

11700 CANTRELL RD SUITE 1
LITTLE ROCK AR
72223-1705
US

V. Phone/Fax

Practice location:
  • Phone: 501-221-2628
  • Fax: 501-221-6787
Mailing address:
  • Phone: 501-221-2628
  • Fax: 501-221-6787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2911
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: