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General NPI Number Information
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NPI Number | 1447875729
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Entity Type | Organization
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Legal Business Name | WARDLAW ORTHODONTICS, P.A.
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 8315 CANTRELL RD STE 100
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City | LITTLE ROCK
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State | AR
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Zip | 72227-2354
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Country | US
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Telephone | 501-227-5757
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Fax | 501-227-0139
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Provider Business Mailing Address
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Address Line | 8315 CANTRELL RD STE 100
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City | LITTLE ROCK
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State | AR
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Zip | 72227-2354
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Country | US
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Telephone | 501-227-5757
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Fax | 501-227-0139
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | MS. KIMBERLY D COVERT
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Credential |
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Telephone | 501-227-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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