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General NPI Number Information
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NPI Number | 1386041549
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Entity Type | Organization
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Legal Business Name | GAVIN TROGDON DDS PA
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 181 W MAIN ST
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City | FARMINGTON
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State | AR
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Zip | 72730-2945
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Country | US
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Telephone | 479-267-5009
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Fax | 479-267-5029
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Provider Business Mailing Address
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Address Line | 181 W MAIN ST
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City | FARMINGTON
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State | AR
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Zip | 72730-2945
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Country | US
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Telephone | 479-267-5009
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Fax | 479-267-5029
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. GAVIN TROGDON
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Credential | DDS, PA
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Telephone | 479-267-5009
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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 | 3959
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License Number State | AR
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