Provider Demographics
NPI:1487023834
Name:DALE M REMERSCHEID DDS PA
Entity Type:Organization
Organization Name:DALE M REMERSCHEID DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:REMERSCHEID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-273-3800
Mailing Address - Street 1:3109 N WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3944
Mailing Address - Country:US
Mailing Address - Phone:479-273-3800
Mailing Address - Fax:
Practice Address - Street 1:3109 N WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3944
Practice Address - Country:US
Practice Address - Phone:479-273-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty