Provider Demographics
NPI:1164516662
Name:PRAETZEL, DARON CARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARON
Middle Name:CARL
Last Name:PRAETZEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MC AULEY COURT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-623-4485
Mailing Address - Fax:501-623-4480
Practice Address - Street 1:200 MCAULEY CT
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6312
Practice Address - Country:US
Practice Address - Phone:501-623-4485
Practice Address - Fax:501-623-4480
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0223611223S0112X
AR771223S0112X
AR3997204E00000X
AR37591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181141679Medicaid