Provider Demographics
NPI:1851661003
Name:DUCK, ANDREW J (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:DUCK
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 1:2111 S OLD MISSOURI RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-8718
Mailing Address - Country:US
Mailing Address - Phone:479-340-0005
Mailing Address - Fax:
Practice Address - Street 1:2111 S OLD MISSOURI RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-8718
Practice Address - Country:US
Practice Address - Phone:479-340-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice