=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093920175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROWE AND ROWE SMILE STUDIO, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 10/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2850 BROWNS LN
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-7236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-932-4126
-----------------------------------------------------
Fax | 870-932-4042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2850 BROWNS LN
-----------------------------------------------------
City | JONESBORO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72401-7236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-932-4126
-----------------------------------------------------
Fax | 870-932-4042
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KRISTY ROBERTS ROWE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 870-932-4126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 3415
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 3341
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------