Provider Demographics
NPI:1457649220
Name:SUFFRIDGE, BUFFORD
Entity Type:Individual
Prefix:
First Name:BUFFORD
Middle Name:
Last Name:SUFFRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7226
Mailing Address - Country:US
Mailing Address - Phone:870-972-8294
Mailing Address - Fax:870-972-6269
Practice Address - Street 1:2606 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7226
Practice Address - Country:US
Practice Address - Phone:870-972-8294
Practice Address - Fax:870-972-6269
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics