# PREMIER DERMATOLOGY & SKIN RENEWAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912912361
- **Authorized official:** MR. JEFF CLIFTON (COO)
- **Authorized official phone:** (479) 273-3376

## Contact information

- **Practice address:** 909 SE 28TH ST, STE 5, BENTONVILLE, AR 72712-3880
- **Practice address phone:** (479) 273-3376
- **Practice address fax:** (479) 273-3468
- **Mailing address:** 909 SE 28TH ST, STE 5, BENTONVILLE, AR 72712-3880
- **Mailing address phone:** (479) 273-3376
- **Mailing address fax:** (479) 273-3468

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | E3363 | AR | — |
| 207NI0002X | Clinical & Laboratory Dermatological Immunology Physician | — | AR | Yes |
| 207NP0225X | Pediatric Dermatology Physician | E3363 | AR | — |
| 207NS0135X | Procedural Dermatology Physician | E3363 | AR | — |

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 09/11/2025