Healthcare Provider Details

I. General information

NPI: 1013188176
Provider Name (Legal Business Name): HUGH F. BURNETT DDS. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 W MARKHAM ST SUITE 300
LITTLE ROCK AR
72205-2175
US

IV. Provider business mailing address

10310 W MARKHAM ST SUITE 300
LITTLE ROCK AR
72205-2175
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-1766
  • Fax: 501-225-1624
Mailing address:
  • Phone: 501-225-1766
  • Fax: 501-225-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3399
License Number StateAR

VIII. Authorized Official

Name: MRS. KAREN JENNINGS SHEPHERD
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-225-1766