Organization
MCQUEEN DENTAL PLLC
Active
Other names
Bold Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VAN MICHAEL MCQUEEN DDS (OWNER)
(870) 926-0471
Entity
Organization
Contact information
Practice address
640 N GARLAND AVE, FAYETTEVILLE, AR 72701-3116
(479) 521-2653
Mailing address
3321 INDIAN SPRINGS AVE, SPRINGDALE, AR 72762-8852
(870) 926-0471
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4178
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518496215
INDIVIDUAL NPI
AR
Enumeration date
05/10/2018
Last updated
05/10/2018
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