Provider Demographics
NPI:1508207283
Name:SPAULDING, PENNY E (DDS)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:E
Last Name:SPAULDING
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 1:900 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2001
Mailing Address - Country:US
Mailing Address - Phone:870-733-6388
Mailing Address - Fax:870-532-6008
Practice Address - Street 1:605 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2034
Practice Address - Country:US
Practice Address - Phone:870-532-6002
Practice Address - Fax:870-532-6008
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3952OtherARKANSAS LICENSE