Healthcare Provider Details

I. General information

NPI: 1689687584
Provider Name (Legal Business Name): TACY MARIE SUNDELL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 CANTRELL RD STE 303
LITTLE ROCK AR
72212-1844
US

IV. Provider business mailing address

11300 CANTRELL RD STE 303
LITTLE ROCK AR
72212-1844
US

V. Phone/Fax

Practice location:
  • Phone: 501-228-5700
  • Fax:
Mailing address:
  • Phone: 501-228-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3352
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: