Organization · Type 2 NPI
Premier Dermatology & Skin Renewal Center
Clinical & Laboratory Dermatological Immunology Physician · Bentonville, AR
Practice location
909 SE 28th St, Ste 5
Bentonville, AR 72712-3880
Fax (479) 273-3468
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology Physician | 207N00000X | E3363 (AR) |
| Pediatric Dermatology Physician | 207NP0225X | E3363 (AR) |
| Procedural Dermatology Physician | 207NS0135X | E3363 (AR) |
| Clinical & Laboratory Dermatological Immunology Physician Primary | 207NI0002X | None listed |
Clinical & Laboratory Dermatological Immunology Physician: A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases.
Another provider at this address
About NPI 1912912361
Premier Dermatology & Skin Renewal Center's National Provider Identifier is 1912912361, issued on Jul 31, 2006. The primary taxonomy on file is Clinical & Laboratory Dermatological Immunology Physician (207NI0002X), and the practice location is in Bentonville, AR. The record was last updated on Sep 11, 2025.