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General NPI Number Information
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NPI Number | 1427700111
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Entity Type | Organization
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Legal Business Name | NORTHEAST ARKANSAS OMFS, PLLC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 2609 BROWNS LN
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City | JONESBORO
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State | AR
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Zip | 72401-7227
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Country | US
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Telephone | 870-931-3000
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Fax | 870-931-0190
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Provider Business Mailing Address
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Address Line | 2609 BROWNS LN
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City | JONESBORO
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State | AR
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Zip | 72401-7227
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Country | US
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Telephone | 870-931-3000
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Fax | 870-931-0190
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Authorized Official
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Title or Position | CEO
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Name | DR. MATTHEW L MCDONOUGH
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Credential |
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Telephone | 870-931-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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