Individual
LOREDANA BANU WYCLIFFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
216 E CARPENTER ST, BENTON, AR 72015-3418
(501) 315-1512
(501) 315-6657
Mailing address
715 MILITARY RD, BENTON, AR 72015-3310
(501) 483-3939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4206
AR
Other
Enumeration date
07/18/2017
Last updated
03/17/2018
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