MEDICARE: JAMES T PHELAN 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2033	AR

General Provider Information

NPI Number	:	1700974979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES T PHELAN DDS

Provider Business Mailing Address
First Line	:	1225 BRECKENRIDGE DR STE 101
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1565
Country	:	US
Telephone Number	:	501-224-6535
Fax Number	:	501-224-8652

Provider Business Practice Location Address
First Line	:	1225 BRECKENRIDGE DR STE 101
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1565
Country	:	US
Telephone Number	:	501-224-6535
Fax Number	:	501-224-8652

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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