Provider Demographics
NPI:1467733139
Name:ARK DENTAL LLC
Entity Type:Organization
Organization Name:ARK DENTAL LLC
Other - Org Name:ARK DENTAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KASEMKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-588-1068
Mailing Address - Street 1:41 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2544
Mailing Address - Country:US
Mailing Address - Phone:413-588-1068
Mailing Address - Fax:857-366-9685
Practice Address - Street 1:41 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2544
Practice Address - Country:US
Practice Address - Phone:413-588-1068
Practice Address - Fax:857-366-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855077305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1588808380Medicare UPIN