Provider Demographics
NPI:1417203282
Name:DRUMMOND, DAVID T (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:DRUMMOND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NW A ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5214
Mailing Address - Country:US
Mailing Address - Phone:479-273-9444
Mailing Address - Fax:479-273-9405
Practice Address - Street 1:210 NW A ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5214
Practice Address - Country:US
Practice Address - Phone:479-273-9444
Practice Address - Fax:479-273-9405
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice