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General NPI Number Information
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NPI Number | 1982806501
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Entity Type | Organization
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Legal Business Name | WADE KIFER D.D.S., P.A.
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1845 N GREEN ACRES RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2615
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Country | US
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Telephone | 479-521-2002
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Fax | 479-444-7202
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Provider Business Mailing Address
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Address Line | 1845 N GREEN ACRES RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2615
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Country | US
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Telephone | 479-521-2002
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Fax | 479-444-7202
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WADE KIFER
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Credential | D.D.S.
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Telephone | 479-521-2002
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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 | 3468
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License Number State | AR
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