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General NPI Number Information
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NPI Number | 1114141231
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Entity Type | Individual
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Provider Name | BOYD OTHO WHITLOCK III DDS, MS, PA
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Gender | Male
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 09/05/2014
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Provider Practice Location Address
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Address Line | 2890 W HUNTSVILLE AVE
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City | SPRINGDALE
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State | AR
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Zip | 72762-7735
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Country | US
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Telephone | 479-751-1103
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Fax | 479-751-3213
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Provider Business Mailing Address
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Address Line | 2890 W HUNTSVILLE AVE
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City | SPRINGDALE
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State | AR
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Zip | 72762-7735
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Country | US
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Telephone | 479-751-1103
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Fax | 479-751-3213
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3000
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License Number State | AR
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