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General NPI Number Information
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NPI Number | 1922523091
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Entity Type | Organization
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Legal Business Name | JAMEY C. TINNIN D.D.S. ENDODONTICS LTD
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 08/09/2017
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Provider Practice Location Address
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Address Line | 1680 E JOYCE BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6214
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Country | US
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Telephone | 479-957-2443
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Fax |
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Provider Business Mailing Address
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Address Line | 1680 E JOYCE BLVD STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-6214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DEANNA CUSHMAN
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Credential |
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Telephone | 479-957-2443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 3148
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License Number State | AR
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