Provider Demographics
NPI:1508089533
Name:STEPHEN AND RACHEL DEAL, DDS, PA
Entity Type:Organization
Organization Name:STEPHEN AND RACHEL DEAL, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-679-4700
Mailing Address - Street 1:17 WILSON FARM RD
Mailing Address - Street 2:P O BOX 310
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9310
Mailing Address - Country:US
Mailing Address - Phone:501-679-4700
Mailing Address - Fax:501-679-4777
Practice Address - Street 1:17 WILSON FARM RD
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9310
Practice Address - Country:US
Practice Address - Phone:501-679-4700
Practice Address - Fax:501-679-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3442261QD0000X
AR3441261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149969608Medicaid
AR150317608Medicaid
AR156759631Medicaid