Provider Demographics
NPI:1942065263
Name:BRADLEY R CROSSFIELD DDS OF NORTHWEST ARKANSAS PLLC
Entity Type:Organization
Organization Name:BRADLEY R CROSSFIELD DDS OF NORTHWEST ARKANSAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-951-0031
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-0677
Mailing Address - Country:US
Mailing Address - Phone:479-326-7551
Mailing Address - Fax:
Practice Address - Street 1:745 E JOYCE BLVD STE 221
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6392
Practice Address - Country:US
Practice Address - Phone:501-951-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty