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General NPI Number Information
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NPI Number | 1073632220
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Entity Type | Individual
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Provider Name | JILL ELIZABETH SELF-PIKE D.M.D
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 3710 SOUTHERN HILLS BLVD STE 700
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City | ROGERS
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State | AR
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Zip | 72758-8094
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Country | US
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Telephone | 479-254-8111
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Fax | 479-254-8112
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Provider Business Mailing Address
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Address Line | 3710 SOUTHERN HILLS BLVD STE 700
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City | ROGERS
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State | AR
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Zip | 72758-8094
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Country | US
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Telephone | 479-936-8600
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Fax | 479-636-1755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3403
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License Number State | AR
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