Organization
WADE KIFER D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WADE KIFER D.D.S. (PRESIDENT)
(479) 521-2002
Entity
Organization
Contact information
Practice address
1845 N GREEN ACRES RD, FAYETTEVILLE, AR 72703-2615
(479) 521-2002
(479) 444-7202
Mailing address
1845 N GREEN ACRES RD, FAYETTEVILLE, AR 72703-2615
(479) 521-2002
(479) 444-7202
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3468
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3468
STATE LICENSE NUMBER
AR
01
—
5 Y 371
BLUE CROSS BLUE SHIELDS
AR
Enumeration date
06/05/2007
Last updated
03/07/2023
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