Healthcare Provider Details

I. General information

NPI: 1891909107
Provider Name (Legal Business Name): PATRICIA MORALES, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 24TH ST
ROGERS AR
72756-3591
US

IV. Provider business mailing address

200 N 24TH ST
ROGERS AR
72756-3591
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-2100
  • Fax: 479-636-2110
Mailing address:
  • Phone: 479-636-2100
  • Fax: 479-636-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number836
License Number StateAR

VIII. Authorized Official

Name: THELMA P MORALES
Title or Position: PRESIDENT
Credential: DDS
Phone: 479-636-2100