Provider Demographics
NPI:1215541271
Name:NORTHEAST ARKANSAS PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:NORTHEAST ARKANSAS PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MCCAA
Authorized Official - Last Name:HIEGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-926-8948
Mailing Address - Street 1:2709 W KINGSHIGHWAY STE 4
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2644
Mailing Address - Country:US
Mailing Address - Phone:870-926-8948
Mailing Address - Fax:
Practice Address - Street 1:2709 W KINGSHIGHWAY STE 4
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2644
Practice Address - Country:US
Practice Address - Phone:870-926-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty