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General NPI Number Information
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NPI Number | 1346479755
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Entity Type | Organization
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Legal Business Name | GARY TUMLISON, DDS
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 810 LOCUST ST.
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City | CONWAY
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State | AR
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Zip | 72034
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Country | US
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Telephone | 501-327-4589
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Fax | 501-327-2871
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Provider Business Mailing Address
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Address Line | 810 LOCUST ST
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City | CONWAY
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State | AR
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Zip | 72034-5331
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Country | US
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Telephone | 501-327-4589
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Fax | 501-327-2871
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | JOHN GARY TUMLISON
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Credential | DDS
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Telephone | 501-327-4589
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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 | 2039
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License Number State | AR
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