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General NPI Number Information
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NPI Number | 1861667131
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Entity Type | Organization
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Legal Business Name | SPADES DENTAL CARE, P.A.
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 900 SOUTHWEST DR STE C&D
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City | JONESBORO
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State | AR
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Zip | 72401-7051
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Country | US
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Telephone | 870-910-0000
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Fax | 870-910-3500
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Provider Business Mailing Address
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Address Line | 900 SOUTHWEST DR STE C&D
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City | JONESBORO
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State | AR
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Zip | 72401-7051
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Country | US
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Telephone | 870-910-0000
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Fax | 870-910-3500
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. WILLIAM AUSTIN SPADES
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Credential | D.D.S.
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Telephone | 870-910-0000
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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 | 3299
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License Number State | AR
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