1184210296 NPI number — BRANDON R STROOPE. DMD. PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184210296 NPI number — BRANDON R STROOPE. DMD. PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRANDON R STROOPE. DMD. PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184210296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3860 HIGHWAY 412 E
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
SILOAM
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72761-8499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-306-6433
Provider Business Mailing Address Fax Number:
479-524-0976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3860 HIGHWAY 412 E
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SILOAM
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72761-8499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-306-6433
Provider Business Practice Location Address Fax Number:
479-524-0976
Provider Enumeration Date:
12/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
STROOPE
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
501-844-5505

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 191410608 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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