MEDICARE: DR. STEPHEN W. BOATRIGHT DDS, FAGD

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	1223E0200X	Endodontics	2911	AR

General Provider Information

NPI Number	:	1275582801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN W. BOATRIGHT DDS, FAGD

Provider Business Mailing Address
First Line	:	11700 CANTRELL RD
Second Line	:	SUITE 1
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-1705
Country	:	US
Telephone Number	:	501-221-2628
Fax Number	:	501-221-6787

Provider Business Practice Location Address
First Line	:	11700 CANTRELL RD
Second Line	:	SUITE 1
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-1705
Country	:	US
Telephone Number	:	501-221-2628
Fax Number	:	501-221-6787

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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