Healthcare Provider Details

I. General information

NPI: 1497668990
Provider Name (Legal Business Name): ROMAN SAPOZHNIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 MAIN ST
VAN BUREN AR
72956-4735
US

IV. Provider business mailing address

12192 PARKER BRANCH RD
WEST FORK AR
72774-9312
US

V. Phone/Fax

Practice location:
  • Phone: 479-474-7076
  • Fax:
Mailing address:
  • Phone: 479-547-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4955
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: