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General NPI Number Information
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NPI Number | 1215641584
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Entity Type | Organization
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Legal Business Name | HAVEN DENTAL CORPORATION
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 2102 FIRST NATIONAL DR
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City | HARRISON
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State | AR
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Zip | 72601-6234
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Country | US
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Telephone | 870-741-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 800 OAKLEY ST
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City | PEA RIDGE
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State | AR
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Zip | 72751-2036
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSHUA DAVID RUBISCH
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Credential | DMD
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Telephone | 479-866-1563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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