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General NPI Number Information
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NPI Number | 1336553361
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Entity Type | Individual
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Provider Name | DOMINIC ANDREW MASSARY III M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/18/2014
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 4803 W HIGHLAND KNOLLS RD STE 300
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City | ROGERS
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State | AR
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Zip | 72758-6447
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Country | US
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Telephone | 479-265-4746
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27157-0001
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | LL37201
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | RTL19-0635
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | E-19002
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License Number State | AR
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