Organization
BOONEVILLE FAMILY DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES WESLEY BORENGASSER D.D.S. (OWNER)
(479) 719-1373
Entity
Organization
Contact information
Practice address
1057 W MAIN ST, BOONEVILLE, AR 72927-3403
(479) 719-1373
Mailing address
9205 ROSEWOOD DR, FORT SMITH, AR 72903-7060
(479) 719-1373
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3525
AR
Other
Enumeration date
02/08/2017
Last updated
02/08/2017
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