Provider Demographics
NPI:1255760120
Name:CULPEPPER FAMILY DENTISTRY
Entity type:Organization
Organization Name:CULPEPPER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-936-8877
Mailing Address - Street 1:620 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3434
Mailing Address - Country:US
Mailing Address - Phone:479-936-8877
Mailing Address - Fax:479-936-8875
Practice Address - Street 1:620 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3434
Practice Address - Country:US
Practice Address - Phone:479-936-8877
Practice Address - Fax:479-936-8875
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. NICHOLAS CULPEPPER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR39541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty