Healthcare Provider Details

I. General information

NPI: 1346658242
Provider Name (Legal Business Name): SHELBY MURAL ESRY D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 S 3RD ST
ROGERS AR
72756-4547
US

IV. Provider business mailing address

214 S 3RD ST
ROGERS AR
72756-4547
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-4771
  • Fax:
Mailing address:
  • Phone: 479-636-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3990
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: