Provider Demographics
NPI:1548035496
Name:CLEFT & CRANIOFACIAL CENTER OF NWA
Entity type:Organization
Organization Name:CLEFT & CRANIOFACIAL CENTER OF NWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:R.DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:800-476-7131
Mailing Address - Street 1:3394 N. FUTRALL DR. STE #2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:800-476-7131
Mailing Address - Fax:
Practice Address - Street 1:3394 N. FUTRALL DR. STE #2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:800-476-7131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center