MEDICARE: R & S DENTAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2787	AR

General Provider Information

NPI Number	:	1134498629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R & S DENTAL SERVICES LLC

Provider Business Mailing Address
First Line	:	5505 EUPER LN
Second Line	:	SUITE B
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3233
Country	:	US
Telephone Number	:	479-650-3257
Fax Number	:	479-478-6122

Provider Business Practice Location Address
First Line	:	5505 EUPER LN
Second Line	:	SUITE B
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3233
Country	:	US
Telephone Number	:	479-650-3257
Fax Number	:	479-478-6122

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. KENDALL ROBERTS
Credential	:	D.D.S.
Telephone Number	:	479-650-3257

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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