| River Valley Pediatric Dentistry Pllc | |
|
417 S 16th St Fort Smith AR 72901-4625 | |
| (479) 783-4182 | |
| (479) 783-4379 |
| Full Name | River Valley Pediatric Dentistry Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 417 S 16th St, Fort Smith, Arkansas |
| Authorized Official Name and Position | Timothy Wayne Lawrence (OWNER) |
| Authorized Official Contact | 4797834182 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| River Valley Pediatric Dentistry Pllc 417 S 16th St Fort Smith AR 72901-4625 Ph: (479) 783-4182 | River Valley Pediatric Dentistry Pllc 417 S 16th St Fort Smith AR 72901-4625 Ph: (479) 783-4182 |
| NPI Number | 1487775011 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 07/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487775011 | NPI | - | NPPES |
| 131026608 | Medicaid | AR | |
| 155183631 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 3089 (Arkansas) | Primary |
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