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General NPI Number Information
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NPI Number | 1154117463
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Entity Type | Organization
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Legal Business Name | PREMIER DERMATOLOGY SERVICES PLLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 901 SE PLAZA AVE STE 5
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City | BENTONVILLE
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State | AR
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Zip | 72712-5473
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Country | US
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Telephone | 479-273-3376
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Fax | 479-273-3468
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Provider Business Mailing Address
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Address Line | 901 SE PLAZA AVE STE 5
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City | BENTONVILLE
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State | AR
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Zip | 72712-5473
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Country | US
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Telephone | 479-273-3376
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Fax | 479-273-3468
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Authorized Official
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Title or Position | PRACTICE DIRECTOR
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Name | MRS. SARA FAST
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Credential |
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Telephone | 479-876-8501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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