Provider Demographics
NPI:1235479874
Name:JAMES L. HIATT, D.D.S., P.L.L.C. (SPRINGDALE)
Entity Type:Organization
Organization Name:JAMES L. HIATT, D.D.S., P.L.L.C. (SPRINGDALE)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-750-0110
Mailing Address - Street 1:601 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5335
Mailing Address - Country:US
Mailing Address - Phone:479-750-0110
Mailing Address - Fax:479-478-1915
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-750-0110
Practice Address - Fax:479-478-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty