Individual
JERRY DEREK FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
125 NORTH RUST AVE, GENTRY, AR 72734
(479) 736-8789
(479) 736-5011
Mailing address
PO BOX 1290, GENTRY, AR 72734-1290
(479) 736-8789
(479) 736-5011
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3095
AR
Other
Enumeration date
08/19/2005
Last updated
07/08/2007
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