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General NPI Number Information
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NPI Number | 1407965106
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Entity Type | Organization
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Legal Business Name | CENTRAL ARKANSAS ORAL & MAXILLOFACIAL SURGERY PA
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 408 W VINE AVE
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City | SEARCY
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State | AR
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Zip | 72143-4141
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Country | US
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Telephone | 501-268-7000
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Fax | 501-279-3606
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Provider Business Mailing Address
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Address Line | 408 WEST VINE
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City | SEARCY
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State | AR
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Zip | 72143
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Country | US
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Telephone | 501-268-7000
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Fax | 501-279-3606
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFF H BYRAM
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Credential | DDS
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Telephone | 501-268-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | LICENSE 3108 SPEC 54
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License Number State | AR
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