Organization
NEIGHBORHOOD DENTAL SERVICES OF NWA, PLLC
Active
Other names
My Village Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM THOMAS MAHON DDS (MANAGER AND SOLE MEMBER)
(479) 619-9052
Entity
Organization
Contact information
Practice address
1909 E CENTRAL AVE, BENTONVILLE, AR 72712-5601
(479) 273-9302
(479) 268-4630
Mailing address
1104 POPLAR PL, ROGERS, AR 72756-4249
(479) 619-9052
(479) 636-5154
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2401
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190167631
—
AR
Enumeration date
02/19/2012
Last updated
02/19/2012
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