MEDICARE: DR. JOHN S TEED DDS

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	122300000X	Dentist	4451	AR
2	122300000X	Dentist	0000011338	TN

General Provider Information

NPI Number	:	1174132914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN S TEED DDS

Provider Business Mailing Address
First Line	:	800 VISTA CV
Second Line	:
City	:	MARION
State	:	AR
Zip	:	72364-9704
Country	:	US
Telephone Number	:	870-245-6329
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 VISTA CV
Second Line	:
City	:	MARION
State	:	AR
Zip	:	72364-9704
Country	:	US
Telephone Number	:	870-245-6329
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	07/28/2020

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Directions to “ DR. JOHN S TEED DDS” Practice Location

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