Provider Demographics
NPI:1003302761
Name:SOUTHERN DENTAL OF FORT SMITH PLLC
Entity Type:Organization
Organization Name:SOUTHERN DENTAL OF FORT SMITH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-243-4406
Mailing Address - Street 1:100 E HUNTINGTON AVE STE E
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2900
Mailing Address - Country:US
Mailing Address - Phone:870-243-4406
Mailing Address - Fax:
Practice Address - Street 1:4208 JENNY LIND RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7660
Practice Address - Country:US
Practice Address - Phone:479-782-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR39301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty