Provider Demographics
NPI:1013043322
Name:RICHARD L. GORE D.D.S.,P.A.
Entity Type:Organization
Organization Name:RICHARD L. GORE D.D.S.,P.A.
Other - Org Name:ASAP SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-225-2929
Mailing Address - Street 1:11 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3843
Mailing Address - Country:US
Mailing Address - Phone:501-225-2929
Mailing Address - Fax:501-228-6646
Practice Address - Street 1:11 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3843
Practice Address - Country:US
Practice Address - Phone:501-225-2929
Practice Address - Fax:501-228-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty