Organization
MAXILLOFACIAL SURGERY CENTER OF CENTRAL ARKANSAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITCH L MITCHELL M.D., D.D.S. (OWNER)
(501) 336-8888
Entity
Organization
Contact information
Practice address
525 WESTERN AVE STE 204, CONWAY, AR 72034-4980
(501) 336-8888
Mailing address
525 WESTERN AVE STE 204, CONWAY, AR 72034-4980
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3079
AR
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
N8414
AR
Other
Enumeration date
05/05/2008
Last updated
05/05/2008
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