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General NPI Number Information
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NPI Number | 1518392331
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Entity Type | Organization
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Legal Business Name | INTEGRATED DENTISTRY
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 03/24/2021
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Provider Practice Location Address
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Address Line | 1101 NORTH EAST MCCLAIN ROAD
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City | BENTONVILLE
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State | AR
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Zip | 72712
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Country | US
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Telephone | 479-250-4473
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Fax | 855-833-1324
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Provider Business Mailing Address
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Address Line | 1101 NORTH EAST MCCLAIN ROAD
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City | BENTONVILLE
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State | AR
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Zip | 72712
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Country | US
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Telephone | 479-250-4473
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Fax | 855-833-1324
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | LORRIN SMITH
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Credential |
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Telephone | 479-250-4473
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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 | AR3739
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License Number State | AR
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