Organization
LEGACY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK REID FAWCETT DDS (GENERAL DENTIST)
(501) 412-2717
Entity
Organization
Contact information
Practice address
901 S PROMENADE BLVD, ROGERS, AR 72758-1801
(501) 412-2717
Mailing address
6791 GARDEN TRAIL AVE, SPRINGDALE, AR 72762-7048
(501) 412-2717
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/14/2025
Last updated
04/14/2025
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