MEDICARE: DR. JOHN RICHARD HOLT HESTIR 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	3948	AR

General Provider Information

NPI Number	:	1205276391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RICHARD HOLT HESTIR DDS

Provider Business Mailing Address
First Line	:	1703 S WHITEHEAD DR
Second Line	:	P O DRAWER 512
City	:	DE WITT
State	:	AR
Zip	:	72042-2911
Country	:	US
Telephone Number	:	870-946-2013
Fax Number	:	870-946-1281

Provider Business Practice Location Address
First Line	:	1703 S WHITEHEAD DR
Second Line	:	P O DRAWER 512
City	:	DE WITT
State	:	AR
Zip	:	72042-2911
Country	:	US
Telephone Number	:	870-946-2013
Fax Number	:	870-946-1281

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

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	07/03/2013

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