Provider Demographics
NPI:1508968207
Name:GARRY L. HARGIS, D.D.S., PA
Entity Type:Organization
Organization Name:GARRY L. HARGIS, D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARGIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-562-5183
Mailing Address - Street 1:8211 GEYER SPRINGS RD
Mailing Address - Street 2:SUITE P-4
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-4952
Mailing Address - Country:US
Mailing Address - Phone:501-562-5183
Mailing Address - Fax:
Practice Address - Street 1:8211 GEYER SPRINGS RD
Practice Address - Street 2:SUITE P-4
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4952
Practice Address - Country:US
Practice Address - Phone:501-562-5183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR106261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA785774OtherUNITED CONCARDIA
AR58280OtherBLUE CROSS BLUE SHIELD