Healthcare Provider Details

I. General information

NPI: 1205857570
Provider Name (Legal Business Name): NICHOLAS CHRIST YIANNIOS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 S PINNACLE HILLS PKWY
ROGERS AR
72758-8897
US

IV. Provider business mailing address

3718 S PINNACLE HILLS PKWY
ROGERS AR
72758-8897
US

V. Phone/Fax

Practice location:
  • Phone: 479-876-8000
  • Fax: 479-876-8878
Mailing address:
  • Phone: 479-876-8000
  • Fax: 479-876-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015680
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3979
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: