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General NPI Number Information
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NPI Number | 1841461274
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Entity Type | Organization
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Legal Business Name | ARKANSAS ORAL SURGERY
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 2425 PRINCE ST SUITE 2
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City | CONWAY
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State | AR
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Zip | 72034-3746
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Country | US
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Telephone | 501-329-3223
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Fax | 501-329-8939
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Provider Business Mailing Address
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Address Line | 2425 PRINCE ST SUITE 2
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City | CONWAY
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State | AR
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Zip | 72034-3746
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Country | US
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Telephone | 501-329-3223
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Fax | 501-329-8939
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. DONNY L QUICK
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Credential | D.D.S.
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Telephone | 501-329-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 65
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License Number State | AR
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