Healthcare Provider Details

I. General information

NPI: 1346784659
Provider Name (Legal Business Name): AXPM- WLR DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 W MARKHAM ST
LITTLE ROCK AR
72205-2316
US

IV. Provider business mailing address

PO BOX 3450
LITTLE ROCK AR
72203-3450
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-6186
  • Fax: 501-227-7540
Mailing address:
  • Phone: 501-781-2777
  • Fax: 501-781-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRYAN HILLER
Title or Position: MANAGER
Credential: DDS
Phone: 501-781-2777