=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255227609
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEYTON GARNETT DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2025
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 459 SLACK STREET
-----------------------------------------------------
City | PEA RIDGE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-930-4100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2704 BAUER ST
-----------------------------------------------------
City | PEA RIDGE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72751-7011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-330-2318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4844
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------