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General NPI Number Information
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NPI Number | 1124385570
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Entity Type | Organization
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Legal Business Name | NORTHEAST ARKANSAS DENTISTRY
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 900 SOUTHWEST DR
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City | JONESBORO
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State | AR
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Zip | 72401-7051
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Country | US
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Telephone | 870-931-6323
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Fax | 870-932-4905
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Provider Business Mailing Address
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Address Line | 900 SOUTHWEST DR
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City | JONESBORO
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State | AR
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Zip | 72401-7051
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Country | US
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Telephone | 870-931-6323
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Fax | 870-932-4905
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH S SPADES
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Credential | DDS
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Telephone | 870-931-6323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3298
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License Number State | AR
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