Healthcare Provider Details

I. General information

NPI: 1669827465
Provider Name (Legal Business Name): BRIAN CHRISTOPHER PLATT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5518 W WALSH LN
ROGERS AR
72758
US

IV. Provider business mailing address

5518 W WALSH LN
ROGERS AR
72758-8947
US

V. Phone/Fax

Practice location:
  • Phone: 479-631-6377
  • Fax:
Mailing address:
  • Phone: 479-631-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4263
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: