Provider Demographics
NPI:1972347441
Name:AUDRA RHODES DDS PA
Entity type:Organization
Organization Name:AUDRA RHODES DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-200-5096
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:71958-0512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:AR
Practice Address - Zip Code:71958-9541
Practice Address - Country:US
Practice Address - Phone:870-285-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental