Healthcare Provider Details

I. General information

NPI: 1730581588
Provider Name (Legal Business Name): AXPM-WLR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16003 CHANEL PARKWAY
LITTLE ROCK AR
72223
US

IV. Provider business mailing address

5100 TALLEY ROAD SUITE 100
LITTLE ROCK AR
72204
US

V. Phone/Fax

Practice location:
  • Phone: 501-712-5080
  • Fax: 501-404-4868
Mailing address:
  • Phone: 501-781-2777
  • Fax: 501-781-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN C. HILLER
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 501-781-2777