=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396261640
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAIR DENTAL ARTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2017
-----------------------------------------------------
Last Update Date | 05/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1616 BELLA VISTA RD
-----------------------------------------------------
City | BENTONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72712-4009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-273-3306
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1616 BELLA VISTA RD
-----------------------------------------------------
City | BENTONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72712-4009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ROBERT EDWARD ADAIR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 479-273-3306
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------