| Ut Pediatric Dentistry | |
|
200 W Tyler Ave West Memphis AR 72301-4223 | |
| (870) 733-3854 | |
| (870) 733-3851 |
| Full Name | Ut Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 200 W Tyler Ave, West Memphis, Arkansas |
| Authorized Official Name and Position | Sanford Jay Fenton (CHAIR) |
| Authorized Official Contact | 8707333854 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ut Pediatric Dentistry 200 W Tyler Ave West Memphis AR 72301-4223 Ph: (870) 733-3854 | Ut Pediatric Dentistry 200 W Tyler Ave West Memphis AR 72301-4223 Ph: (870) 733-3854 |
| NPI Number | 1407988116 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 03/19/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407988116 | NPI | - | NPPES |
| 150226608 | Medicaid | AR | |
| 107199608 | Medicaid | AR | |
| 111494608 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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