Provider Demographics
NPI:1922166610
Name:BILL PICKARD, DDS, MS, PA
Entity Type:Organization
Organization Name:BILL PICKARD, DDS, MS, PA
Other - Org Name:ARKANSAS ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PA
Authorized Official - Phone:479-442-3411
Mailing Address - Street 1:3533 N SHILOH DR STE 3
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5317
Mailing Address - Country:US
Mailing Address - Phone:479-442-3411
Mailing Address - Fax:479-442-3901
Practice Address - Street 1:3533 N SHILOH DR STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5317
Practice Address - Country:US
Practice Address - Phone:479-442-3411
Practice Address - Fax:479-442-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR20351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR814087OtherUNITED CONCORDIA
AR5F642OtherARKANSAS BCBS