=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922166610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BILL PICKARD, DDS, MS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3533 N SHILOH DR STE 3
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703-5317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-442-3411
-----------------------------------------------------
Fax | 479-442-3901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3533 N SHILOH DR STE 3
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703-5317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-442-3411
-----------------------------------------------------
Fax | 479-442-3901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER,ORTHODONTIST
-----------------------------------------------------
Name | DR. BILL PICKARD
-----------------------------------------------------
Credential | DDS, MS, PA
-----------------------------------------------------
Telephone | 479-442-3411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 2035
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------