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General NPI Number Information
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NPI Number | 1508054214
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Entity Type | Organization
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Legal Business Name | S TODD PHELAN, DDS, PA
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 2102 W PLEASANT GROVE RD SUITE 1
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City | ROGERS
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State | AR
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Zip | 72758
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Country | US
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Telephone | 479-636-3400
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Fax | 479-636-3407
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Provider Business Mailing Address
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Address Line | 2102 W PLEASANT GROVE RD SUITE 1
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City | ROGERS
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State | AR
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Zip | 72758
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Country | US
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Telephone | 479-636-3400
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Fax | 479-636-3407
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TODD PHELAN
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Credential | DDS
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Telephone | 479-636-3400
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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 | 3489
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License Number State | AR
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