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General NPI Number Information
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NPI Number | 1114638640
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Entity Type | Organization
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Legal Business Name | COREY INBODEN DDS, PLLC
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 179 N CHURCH AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5265
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Country | US
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Telephone | 479-442-6512
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 E GOLDEN OAKS DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3152
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Country | US
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Telephone | 870-219-4046
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM COREY INBODEN
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Credential | DDS
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Telephone | 870-219-4046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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