Provider Demographics
NPI:1508988585
Name:PHELAN ORTHODONTICS, PA
Entity Type:Organization
Organization Name:PHELAN ORTHODONTICS, PA
Other - Org Name:PHELAN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:501-224-6535
Mailing Address - Street 1:1801 RAHLING RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4777
Mailing Address - Country:US
Mailing Address - Phone:501-224-6535
Mailing Address - Fax:501-224-8652
Practice Address - Street 1:1801 RAHLING RD STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4777
Practice Address - Country:US
Practice Address - Phone:501-224-6535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty