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General NPI Number Information
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NPI Number | 1760709844
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Entity Type | Organization
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Legal Business Name | DAVID L. GRACE D.D.S.
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 2017 N GREEN ACRES RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2619
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Country | US
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Telephone | 479-442-9871
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Fax | 479-444-0043
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Provider Business Mailing Address
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Address Line | 2017 N GREEN ACRES RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2619
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Country | US
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Telephone | 479-442-9871
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Fax | 479-444-0043
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Authorized Official
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Title or Position | DENTIST
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Name | MR. DAVID L GRACE
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Credential | D.D.S.
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Telephone | 479-442-9871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2331
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License Number State | AR
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