Provider Demographics
NPI:1508334400
Name:SMILE SHOPPE FAYETTEVILLE JEFFREY D. RHODES DDS MS PLLC
Entity Type:Organization
Organization Name:SMILE SHOPPE FAYETTEVILLE JEFFREY D. RHODES DDS MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-631-6377
Mailing Address - Street 1:5518 W WALSH LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8947
Mailing Address - Country:US
Mailing Address - Phone:479-631-6377
Mailing Address - Fax:
Practice Address - Street 1:3484 W WEDINGTON DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5730
Practice Address - Country:US
Practice Address - Phone:479-631-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty