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General NPI Number Information
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NPI Number | 1619866910
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Entity Type | Individual
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Provider Name | PEYTON REED FAULKNER DDS
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Gender | Male
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Dates
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Enumeration Date | 07/01/2025
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 3922 E MAIN ST STE D
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-6813
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Country | US
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Telephone | 870-762-1331
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Fax |
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Provider Business Mailing Address
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Address Line | 423 PINE ST
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-9227
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Country | US
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Telephone | 573-724-2211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4871
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License Number State | AR
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