Healthcare Provider Details

I. General information

NPI: 1407965106
Provider Name (Legal Business Name): CENTRAL ARKANSAS ORAL & MAXILLOFACIAL SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 W VINE AVE
SEARCY AR
72143-4141
US

IV. Provider business mailing address

408 WEST VINE
SEARCY AR
72143
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-7000
  • Fax: 501-279-3606
Mailing address:
  • Phone: 501-268-7000
  • Fax: 501-279-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberLICENSE 3108 SPEC 54
License Number StateAR

VIII. Authorized Official

Name: JEFF H BYRAM
Title or Position: PRESIDENT
Credential: DDS
Phone: 501-268-7000