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General NPI Number Information
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NPI Number | 1760740799
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Entity Type | Organization
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Legal Business Name | WEDINGTON COURT DENTAL ASSOCIATES
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 1188 N SALEM RD #10
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-8807
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Country | US
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Telephone | 479-527-0707
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Fax | 479-527-0201
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Provider Business Mailing Address
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Address Line | 1188 N SALEM RD #10
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-8807
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Country | US
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Telephone | 479-527-0707
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Fax | 479-527-0201
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GARY G GUTHRIE
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Credential | DDS
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Telephone | 479-527-0707
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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 | 2977
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License Number State | AR
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