Healthcare Provider Details

I. General information

NPI: 1912100322
Provider Name (Legal Business Name): STEPHEN W. BOATRIGHT, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/22/2020
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 Number22
License Number StateMD

VIII. Authorized Official

Name: DR. STEPHEN BOATRIGHT
Title or Position: OWNER
Credential: DDS
Phone: 501-221-2628