Provider Demographics
NPI:1043384381
Name:DENTAL HEALTH CENTER OF ARKANSAS, P.A.
Entity Type:Organization
Organization Name:DENTAL HEALTH CENTER OF ARKANSAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAED
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUSALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-812-4949
Mailing Address - Street 1:2550 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2316
Mailing Address - Country:US
Mailing Address - Phone:501-812-4949
Mailing Address - Fax:501-812-4994
Practice Address - Street 1:2550 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2316
Practice Address - Country:US
Practice Address - Phone:501-812-4949
Practice Address - Fax:501-812-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty