Healthcare Provider Details

I. General information

NPI: 1689689440
Provider Name (Legal Business Name): WILLIAM M FLURRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 BASELINE RD
LITTLE ROCK AR
72209-4436
US

IV. Provider business mailing address

7301 BASELINE RD
LITTLE ROCK AR
72209-4436
US

V. Phone/Fax

Practice location:
  • Phone: 501-565-3943
  • Fax:
Mailing address:
  • Phone: 501-565-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2252
License Number StateAR

VIII. Authorized Official

Name: DR. WILLIAM M FLURRY
Title or Position: OWENER
Credential: D.D.S
Phone: 501-565-3943