Provider Demographics
NPI:1568525731
Name:FAULKNER, RONNIE LEE (DDS)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:LEE
Last Name:FAULKNER
Suffix:
Gender:M
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:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:MOUNT IDA
Mailing Address - State:AR
Mailing Address - Zip Code:71957-0901
Mailing Address - Country:US
Mailing Address - Phone:870-867-3432
Mailing Address - Fax:870-867-3783
Practice Address - Street 1:138 HWY 270 EAST
Practice Address - Street 2:
Practice Address - City:MOUNT IDA
Practice Address - State:AR
Practice Address - Zip Code:71957-0901
Practice Address - Country:US
Practice Address - Phone:870-867-3432
Practice Address - Fax:870-867-3783
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR26881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice