Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 18 | AR |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2 | AR |
NPI | 1386617751 |
---|---|
Provider Name | Dr. Steven Bryan Whitaker |
First Address | Fayetteville, AR 72701-4349 |
Second Address | Springdale, AR 72762-7726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 02/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3249 | STATE LICENSE (01) | AR |