Provider Demographics
NPI:1003403627
Name:THE DENTAL CLINIC, INC
Entity Type:Organization
Organization Name:THE DENTAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:LEUNG
Authorized Official - Last Name:MCCLESKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-935-0242
Mailing Address - Street 1:2239 S CARAWAY RD STE S
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6234
Mailing Address - Country:US
Mailing Address - Phone:870-935-0242
Mailing Address - Fax:870-935-4058
Practice Address - Street 1:2239 S CARAWAY RD STE S
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6234
Practice Address - Country:US
Practice Address - Phone:870-935-0242
Practice Address - Fax:870-935-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental