Provider Demographics
NPI:1881852499
Name:WEATHERFORD, MARY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 JULIA AVE E
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3504
Mailing Address - Country:US
Mailing Address - Phone:870-238-2600
Mailing Address - Fax:870-238-5522
Practice Address - Street 1:620 JULIA AVE E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3504
Practice Address - Country:US
Practice Address - Phone:870-208-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist