Provider Demographics
NPI:1780771907
Name:DWIGHT D. DUCKWORTH, DDS, PA
Entity type:Organization
Organization Name:DWIGHT D. DUCKWORTH, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:DEBUSK
Authorized Official - Last Name:DUCKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-750-0333
Mailing Address - Street 1:6815 ISAACS ORCHARD RD STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6285
Mailing Address - Country:US
Mailing Address - Phone:479-750-0333
Mailing Address - Fax:479-306-6971
Practice Address - Street 1:6815 ISAACS ORCHARD RD STE A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6285
Practice Address - Country:US
Practice Address - Phone:479-750-0333
Practice Address - Fax:479-306-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty