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General NPI Number Information
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NPI Number | 1992078125
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Entity Type | Organization
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Legal Business Name | NEIGHBORHOOD DENTAL SERVICES OF NWA, PLLC
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Dates
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Enumeration Date | 02/19/2012
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Last Update Date | 02/19/2012
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Provider Practice Location Address
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Address Line | 1909 E CENTRAL AVE
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City | BENTONVILLE
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State | AR
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Zip | 72712-5601
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Country | US
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Telephone | 479-273-9302
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Fax | 479-268-4630
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Provider Business Mailing Address
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Address Line | 1104 POPLAR PL
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City | ROGERS
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State | AR
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Zip | 72756-4249
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Country | US
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Telephone | 479-619-9052
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Fax | 479-636-5154
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Authorized Official
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Title or Position | MANAGER AND SOLE MEMBER
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Name | DR. WILLIAM THOMAS MAHON
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Credential | DDS
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Telephone | 479-619-9052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2401
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License Number State | AR
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