Provider Demographics
NPI:1518365048
Name:THE DENTAL CLINIC AT STUTTGART
Entity Type:Organization
Organization Name:THE DENTAL CLINIC AT STUTTGART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-551-3836
Mailing Address - Street 1:2022 S BUERKLE ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-6508
Mailing Address - Country:US
Mailing Address - Phone:870-673-6994
Mailing Address - Fax:870-673-6995
Practice Address - Street 1:2022 S BUERKLE ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-6508
Practice Address - Country:US
Practice Address - Phone:870-673-6994
Practice Address - Fax:870-673-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2020-08-19
Deactivation Date:2019-01-18
Deactivation Code:
Reactivation Date:2019-02-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty