Provider Demographics
NPI:1366639585
Name:MARKS CHILDREN'S DENTISTRY
Entity Type:Organization
Organization Name:MARKS CHILDREN'S DENTISTRY
Other - Org Name:SALINE COUNTY CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-847-7070
Mailing Address - Street 1:2305 SPRINGHILL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7552
Mailing Address - Country:US
Mailing Address - Phone:501-847-7070
Mailing Address - Fax:
Practice Address - Street 1:2305 SPRINGHILL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-7552
Practice Address - Country:US
Practice Address - Phone:501-847-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR36191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty