Organization
W.DARREL FAIN D.D.S. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM DARREL FAIN (OWNER)
(870) 887-5051
Entity
Organization
Contact information
Practice address
419 E 6TH ST S, PRESCOTT, AR 71857-2432
(870) 887-5051
Mailing address
419 E 6TH ST S, PRESCOTT, AR 71857-2432
(870) 887-5051
(870) 887-6400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2114
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116984831
—
AR
01
—
2114
DELTA DENTAL
AR
01
—
58267
BLUE CROSS BLUE SHIELD
AR
Enumeration date
12/12/2006
Last updated
08/26/2008
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