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NPI Code Detail

MEDICARE: RALPH A TEED D.D.S.,P.A

MEDICARE: RALPH A TEED D.D.S.,P.A
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
11223G0001XGeneral Practice Dentistry2453AR

General Provider Information

NPI Number : 1902830722
Entity Type Code : Individual
Provider Name (Legal Business Name) : RALPH A TEED D.D.S.,P.A
Provider Business Mailing Address
First Line : 5405 CORD RD
Second Line :
City : NEWARK
State : AR
Zip : 72562-9489
Country : US
Telephone Number : 870-523-6555
Fax Number :
Provider Business Practice Location Address
First Line : 1200 MCLAIN ST STE 8
Second Line : SUITE 8
City : NEWPORT
State : AR
Zip : 72112-3534
Country : US
Telephone Number : 870-523-6555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 07/08/2007

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