Provider Demographics
NPI:1093463424
Name:JOHN PARDO, DDS , PLLC
Entity Type:Organization
Organization Name:JOHN PARDO, DDS , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-538-3545
Mailing Address - Street 1:401 E BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-2907
Mailing Address - Country:US
Mailing Address - Phone:214-538-3545
Mailing Address - Fax:
Practice Address - Street 1:401 E BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE GROVE
Practice Address - State:AR
Practice Address - Zip Code:72753-2907
Practice Address - Country:US
Practice Address - Phone:479-846-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1609238807OtherNPI TYPE 1