Provider Demographics
NPI:1134502628
Name:PELPHREY, ROSEMARY (DDS)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:PELPHREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SW RAMSEY LN
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4859
Mailing Address - Country:US
Mailing Address - Phone:806-252-2481
Mailing Address - Fax:
Practice Address - Street 1:400 SW RAMSEY LN
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4859
Practice Address - Country:US
Practice Address - Phone:806-778-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311321223G0001X
AR42871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice