Provider Demographics
NPI:1528006186
Name:R. E. HAMBUCHEN D.D.S. P.A.
Entity Type:Organization
Organization Name:R. E. HAMBUCHEN D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAMBUCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-329-8754
Mailing Address - Street 1:550 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5402
Mailing Address - Country:US
Mailing Address - Phone:501-329-8754
Mailing Address - Fax:501-329-2530
Practice Address - Street 1:550 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5402
Practice Address - Country:US
Practice Address - Phone:501-329-8754
Practice Address - Fax:501-329-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR167261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental