Provider Demographics
NPI:1912100322
Name:STEPHEN W. BOATRIGHT, DDS, PA
Entity Type:Organization
Organization Name:STEPHEN W. BOATRIGHT, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-221-2628
Mailing Address - Street 1:11700 CANTRELL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1705
Mailing Address - Country:US
Mailing Address - Phone:501-221-2628
Mailing Address - Fax:501-221-6787
Practice Address - Street 1:11700 CANTRELL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1705
Practice Address - Country:US
Practice Address - Phone:501-221-2628
Practice Address - Fax:501-221-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty