Provider Demographics
NPI:1346760519
Name:MOUNTS DENTAL CARE
Entity Type:Organization
Organization Name:MOUNTS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:501-753-0166
Mailing Address - Street 1:2512 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7623
Mailing Address - Country:US
Mailing Address - Phone:501-753-0166
Mailing Address - Fax:501-753-1071
Practice Address - Street 1:2512 CRESTWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7623
Practice Address - Country:US
Practice Address - Phone:501-753-0166
Practice Address - Fax:501-753-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty