Provider Demographics
NPI:1679669535
Name:JEFF A. POWELL, D.D.S.
Entity Type:Organization
Organization Name:JEFF A. POWELL, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-834-4800
Mailing Address - Street 1:7522 HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4645
Mailing Address - Country:US
Mailing Address - Phone:501-834-4800
Mailing Address - Fax:501-833-1414
Practice Address - Street 1:7522 HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-4645
Practice Address - Country:US
Practice Address - Phone:501-834-4800
Practice Address - Fax:501-833-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134195608Medicaid
AR5T971OtherBLUE CROSS BLUE SHEILD
PA975116OtherUNITED CONCORDIA