Healthcare Provider Details

I. General information

NPI: 1013497957
Provider Name (Legal Business Name): BENJAMIN CHRISTIAN ESLICK BT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 COUNTRY CLUB RD
SHERWOOD AR
72120-5095
US

IV. Provider business mailing address

2740 COLLEGE AVE
CONWAY AR
72034-6141
US

V. Phone/Fax

Practice location:
  • Phone: 501-753-5459
  • Fax: 501-753-5463
Mailing address:
  • Phone: 501-329-5459
  • Fax: 501-327-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: