Healthcare Provider Details

I. General information

NPI: 1326345323
Provider Name (Legal Business Name): PATTON MARK MINKIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 W HUNTSVILLE AVE
SPRINGDALE AR
72762-7726
US

IV. Provider business mailing address

2926 W HUNTSVILLE AVE
SPRINGDALE AR
72762-7726
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-3000
  • Fax: 479-927-3085
Mailing address:
  • Phone: 479-582-3000
  • Fax: 479-927-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4232
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4232
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: