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General NPI Number Information
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NPI Number | 1912500364
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Entity Type | Organization
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Legal Business Name | RONNIE L FAULKNER, DDS, PA
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 138 HIGHWAY 270 E
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City | MOUNT IDA
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State | AR
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Zip | 71957-9409
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Country | US
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Telephone | 870-867-3432
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Fax | 870-867-3783
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Provider Business Mailing Address
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Address Line | PO BOX 901
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City | MOUNT IDA
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State | AR
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Zip | 71957-0901
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Country | US
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Telephone | 870-867-3432
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Fax | 870-867-3783
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Authorized Official
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Title or Position | PRESIDE
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Name | RONNIE LEE FAULKNER
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Credential | DDS
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Telephone | 501-276-3432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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