Organization
RIVER VALLEY PEDIATRIC DENTISTRY PLLC
Active
Other names
johnston lawrence river valley pediatric dentistry pllc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY WAYNE LAWRENCE (OWNER)
(479) 783-4182
Entity
Organization
Contact information
Practice address
417 S 16TH ST, FORT SMITH, AR 72901-4625
(479) 783-4182
(479) 783-4379
Mailing address
417 S 16TH ST, FORT SMITH, AR 72901-4625
(479) 783-4182
(479) 783-4379
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3089
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131026608
—
AR
05
—
155183631
—
AR
Enumeration date
04/02/2007
Last updated
07/01/2008
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