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General NPI Number Information
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NPI Number | 1043101116
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Entity Type | Organization
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Legal Business Name | CENTERTON ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 1305 E CENTERTON BLVD
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City | CENTERTON
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State | AR
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Zip | 72719
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Country | US
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Telephone | 479-412-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 730 BRONCO ST
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City | CENTERTON
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State | AR
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Zip | 72719-4019
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Country | US
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Telephone | 479-207-2318
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. SKYLAR P MAXWELL
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Credential | D.D.S, M.S.
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Telephone | 479-207-2318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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