Pea Ridge Family & Cosmetic Dentistry by Wisener, Cooper, & Fergus

NPI #1043671332 in Pea Ridge, Arkansas

Provider Information

NPI Number: 1043671332
Entity Type: Organization
Organization Name: Pea Ridge Family & Cosmetic Dentistry by Wisener, Cooper, & Fergus
Subpart: Yes (part of a larger organization)
Parent Organization: WISENER, COOPER, & FERGUS, DDS,PLLC
Primary Specialty: Dentist
Enumeration Date: Mar 14, 2016
Last Updated: Mar 14, 2016

Practice Location

Address: 833 N CURTIS AVE
City: Pea Ridge
State: Arkansas
ZIP Code: 72751-2930
Phone: (479) 488-6288

Authorized Official

Name: MRS. GAY LYNN WELDEN
Title: OFFICE MANAGER
Phone: (479) 636-7100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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