Healthcare Provider Details

I. General information

NPI: 1255760120
Provider Name (Legal Business Name): CULPEPPER FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N 13TH ST
ROGERS AR
72756-3434
US

IV. Provider business mailing address

620 N 13TH ST
ROGERS AR
72756-3434
US

V. Phone/Fax

Practice location:
  • Phone: 479-936-8877
  • Fax: 479-936-8875
Mailing address:
  • Phone: 479-936-8877
  • Fax: 479-936-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3954
License Number StateAR

VIII. Authorized Official

Name: LAURA OSMER
Title or Position: OFFICE MANAGER
Credential:
Phone: 479-936-8877