Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019.032082 | IL |
N | 1223G0001X | General Practice | 3770 | AR |
N | 213EG0000X | General Practice | 3770 | AR |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3770 | AR |
NPI | 1114248655 |
---|---|
Provider Name | Dr. Sloan Boyd Ashabranner |
First Address | Fayetteville, AR 72703-2619 |
Second Address | Chicago, IL 60612-7210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2010 |
Last Update Date | 25/10/2021 |