Provider Demographics
NPI:1134485170
Name:DRS WEDDLE AND BAUMSARDNER
Entity Type:Organization
Organization Name:DRS WEDDLE AND BAUMSARDNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-863-8161
Mailing Address - Street 1:106 WEST MAIN SUITE 212
Mailing Address - Street 2:DRS WEDDLE & BAUMSARDNER
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-863-8161
Mailing Address - Fax:870-863-8356
Practice Address - Street 1:106 WEST MAIN ST. 212
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-863-8161
Practice Address - Fax:870-863-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty