Provider Demographics
NPI:1255404703
Name:HONEYCUTT, JOHN H SR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:HONEYCUTT
Suffix:SR
Gender:M
Credentials:DDS
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Mailing Address - Street 1:1 MEDICAL DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4017
Mailing Address - Country:US
Mailing Address - Phone:870-239-4006
Mailing Address - Fax:870-239-4007
Practice Address - Street 1:1 MEDICAL DR
Practice Address - Street 2:SUITE 600
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4017
Practice Address - Country:US
Practice Address - Phone:870-239-4006
Practice Address - Fax:870-239-4007
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AR21571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
853812OtherUNITED CONCORDIA
58502OtherBLUE CROSS BLUE SHIELD