Provider Demographics
NPI:1235538778
Name:KARLA K. GAINES, D.D.S., P.A.
Entity Type:Organization
Organization Name:KARLA K. GAINES, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-936-8800
Mailing Address - Street 1:802 N DIXIELAND RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3205
Mailing Address - Country:US
Mailing Address - Phone:479-936-8800
Mailing Address - Fax:479-936-8808
Practice Address - Street 1:802 N DIXIELAND RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3205
Practice Address - Country:US
Practice Address - Phone:479-936-8800
Practice Address - Fax:479-936-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR30981223G0001X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125300608Medicaid