Organization
TERRY L. FIDDLER, D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SISSY MOORE (OFFICE MANAGER)
(501) 327-7778
Entity
Organization
Contact information
Practice address
562 LOCUST STREET, CONWAY, AR 72034
(501) 327-7778
Mailing address
562 LOCUST STREET, CONWAY, AR 72034
(501) 327-7778
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2115
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58493
BLUE CROSS BLUE SHIELD
AR
01
—
858661
UNITED CONCORDIA
AR
Enumeration date
10/04/2006
Last updated
08/22/2020
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