Provider Demographics
NPI:1174816706
Name:C. ED KNIGHT, D.D.S., P.A.
Entity Type:Organization
Organization Name:C. ED KNIGHT, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-224-3008
Mailing Address - Street 1:9601 LILE DR STE 240
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6342
Mailing Address - Country:US
Mailing Address - Phone:501-224-3008
Mailing Address - Fax:501-224-3009
Practice Address - Street 1:9601 LILE DR STE 240
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6342
Practice Address - Country:US
Practice Address - Phone:501-224-3008
Practice Address - Fax:501-224-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56262Medicare UPIN