Provider Demographics
NPI:1477795730
Name:DUMAS FAMILY DENTAL CENTER LLC
Entity Type:Organization
Organization Name:DUMAS FAMILY DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-753-2800
Mailing Address - Street 1:601 MEADOR DR
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-2824
Mailing Address - Country:US
Mailing Address - Phone:501-753-2800
Mailing Address - Fax:
Practice Address - Street 1:601 MEADOR DR
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-2824
Practice Address - Country:US
Practice Address - Phone:501-753-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty