Organization
RIVER VALLEY ORAL & MAXILLOFACIAL SURGERY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GAYLE M. FREEMAN (OFFICE MANAGER)
(479) 484-1011
Entity
Organization
Contact information
Practice address
2407 S WALDRON RD, FORT SMITH, AR 72903-3736
(479) 484-1011
(479) 484-1205
Mailing address
2407 S WALDRON RD, FORT SMITH, AR 72903-3736
(479) 484-1011
(479) 484-1205
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2226
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000516007
UNITED CONCORDIA (IND-JR)
—
01
—
000812852
UNITED CONCORDIA (IND-JB)
—
01
—
000861460
UNITED CONCORDIA (GRP)
—
05
—
100026580A
—
OK
05
—
100174630A
—
OK
05
—
127321679
—
AR
05
—
127322679
—
AR
01
—
1629038708
INDIVIDUAL NPI
—
01
—
1871553958
INDIVIDUAL NPI
—
01
—
58041
BLUE CROSS BLUE SHIELD
AR
01
—
58111
BLUE CROSS BLUE SHIELD
AR
Enumeration date
07/18/2006
Last updated
04/27/2009
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