| |
715 Calvin Avery West Memphis AR 72301 | |
(870) 735-3601 | |
(870) 732-9535 |
Full Name | |
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Speciality | Dentist |
Location | 715 Calvin Avery, West Memphis, Arkansas |
Authorized Official Name and Position | Charles S Wood (OWNER) |
Authorized Official Contact | 8707353601 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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715 Calvin Avery Dr West Memphis AR 72301 Ph: (870) 735-3601 | 715 Calvin Avery West Memphis AR 72301 Ph: (870) 735-3601 |
NPI Number | 1508962937 |
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Provider Enumeration Date | 09/15/2006 |
Last Update Date | 10/01/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508962937 | NPI | - | NPPES |
101993608 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Primary |
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