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General NPI Number Information
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NPI Number | 1811493828
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Entity Type | Organization
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Legal Business Name | SOH OF ARKANSAS WILLIAM WELLFORD PORTER PC
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Dates
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Enumeration Date | 03/30/2018
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 2868 W MARTIN LUTHER KING BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-7625
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Country | US
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Telephone | 479-249-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 ELBRIDGE PAYNE RD STE 240
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City | CHESTERFIELD
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State | MO
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Zip | 63017-8544
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Country | US
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Telephone | 314-753-8154
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Fax |
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Authorized Official
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Title or Position | REGIONAL SUPPORT SPECIALIST
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Name | MR. RAYMOND WEBER
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Credential |
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Telephone | 314-753-8154
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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 |
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License Number State |
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