Provider Demographics
NPI:1053637637
Name:GAIRHAN DENTAL CARE, PLLC
Entity Type:Organization
Organization Name:GAIRHAN DENTAL CARE, PLLC
Other - Org Name:GAIRHAN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:BALLARD
Authorized Official - Last Name:GAIRHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-931-1100
Mailing Address - Street 1:460 SOUTHWEST DR STE B
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5855
Mailing Address - Country:US
Mailing Address - Phone:870-931-1100
Mailing Address - Fax:870-931-1101
Practice Address - Street 1:460 SOUTHWEST DR STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5855
Practice Address - Country:US
Practice Address - Phone:870-931-1100
Practice Address - Fax:870-931-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR37091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841428117OtherTYPE 1 NPI
AR179731608Medicaid