Provider Demographics
NPI:1104028844
Name:THOMAS R. PIERCE JR., DDS
Entity Type:Organization
Organization Name:THOMAS R. PIERCE JR., DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE LYNN
Authorized Official - Middle Name:HUTCHINSON
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:870-739-3256
Mailing Address - Street 1:329 BLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2103
Mailing Address - Country:US
Mailing Address - Phone:870-739-3256
Mailing Address - Fax:870-739-3796
Practice Address - Street 1:329 BLOCK ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2103
Practice Address - Country:US
Practice Address - Phone:870-739-3256
Practice Address - Fax:870-739-3796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR$$$$$$$$$OtherINDIV SSN
AR58555OtherINDIV BCBS OF AR
TN3031930OtherINDIV BCBS OF TN #
AR831339OtherINDIV UNITED CONCORDIA #