Healthcare Provider Details

I. General information

NPI: 1932497096
Provider Name (Legal Business Name): PATRICK E DRIVER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

14000 NAPOLEON RD
LITTLE ROCK AR
72211-5541
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-2200
  • Fax:
Mailing address:
  • Phone: 816-585-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2010016291
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4105
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: