Provider Demographics
NPI:1073683827
Name:PURYEAR, GEORGE SCOTT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SCOTT
Last Name:PURYEAR
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:PURYEAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:715 ELDRIDGE AVE E
Mailing Address - Street 2:715 E. ELDRIDGE AVE
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-4032
Mailing Address - Country:US
Mailing Address - Phone:870-238-3628
Mailing Address - Fax:870-238-0757
Practice Address - Street 1:715 E. ELDRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396
Practice Address - Country:US
Practice Address - Phone:870-238-3628
Practice Address - Fax:870-238-0757
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3101742OtherTNBCBS
AR58710OtherARBCBS
AR102044608Medicaid
AR842108OtherUNITED CONCORDIA
AR102044608Medicaid