Provider Demographics
NPI:1124385570
Name:NORTHEAST ARKANSAS DENTISTRY
Entity Type:Organization
Organization Name:NORTHEAST ARKANSAS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPADES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-931-6323
Mailing Address - Street 1:900 SOUTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7051
Mailing Address - Country:US
Mailing Address - Phone:870-931-6323
Mailing Address - Fax:870-932-4905
Practice Address - Street 1:900 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7051
Practice Address - Country:US
Practice Address - Phone:870-931-6323
Practice Address - Fax:870-932-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty