Organization
RICHARD L. WIEDOWER, D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA A. SANDERS (OFFICE MANAGER)
(501) 327-9988
Entity
Organization
Contact information
Practice address
810 SALEM RD, CONWAY, AR 72034-4800
(501) 327-9988
(501) 327-9991
Mailing address
810 SALEM RD, CONWAY, AR 72034-4800
(501) 327-9988
(501) 327-9991
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2704
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150619608
—
AR
01
—
59167
BCBS
AR
01
—
849711
UCCI
AR
Enumeration date
08/06/2008
Last updated
08/06/2008
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