Provider Demographics
NPI:1275771552
Name:PARADIGM FAMILY DENTISTRY, PLLC
Entity Type:Organization
Organization Name:PARADIGM FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:TREHLET
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-481-0476
Mailing Address - Street 1:101 W. PARKIN AVENUE
Mailing Address - Street 2:P.O. BOX 6
Mailing Address - City:PARKIN
Mailing Address - State:AR
Mailing Address - Zip Code:72373-9998
Mailing Address - Country:US
Mailing Address - Phone:901-481-0476
Mailing Address - Fax:901-758-2297
Practice Address - Street 1:101 W PARKIN AVENUE
Practice Address - Street 2:
Practice Address - City:PARKIN
Practice Address - State:AR
Practice Address - Zip Code:72373-9998
Practice Address - Country:US
Practice Address - Phone:901-481-0476
Practice Address - Fax:901-758-2297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty