Provider Demographics
NPI:1083032312
Name:CENTURY DENTAL
Entity Type:Organization
Organization Name:CENTURY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:GAMBILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-632-8889
Mailing Address - Street 1:641 HIGHWAY 71 N
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-5107
Mailing Address - Country:US
Mailing Address - Phone:479-632-8889
Mailing Address - Fax:479-632-8870
Practice Address - Street 1:641 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-5107
Practice Address - Country:US
Practice Address - Phone:479-632-8889
Practice Address - Fax:479-632-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2868302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization