Provider Demographics
NPI:1821001637
Name:DRS. WOODARD & SUNDELL, DDS, PA
Entity Type:Organization
Organization Name:DRS. WOODARD & SUNDELL, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-228-5700
Mailing Address - Street 1:11300 CANTRELL RD STE 303
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-1844
Mailing Address - Country:US
Mailing Address - Phone:501-228-5700
Mailing Address - Fax:501-228-5702
Practice Address - Street 1:11300 CANTRELL RD STE 303
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-1844
Practice Address - Country:US
Practice Address - Phone:501-228-5700
Practice Address - Fax:501-228-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34231223P0106X
AR33521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR=========OtherTAX ID
AR=========OtherTAX ID