Provider Demographics
NPI:1558814178
Name:SOUTHERN DENTAL OF MUNFORD PLLC
Entity Type:Organization
Organization Name:SOUTHERN DENTAL OF MUNFORD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-972-1200
Mailing Address - Street 1:PO BOX 17151
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6720
Mailing Address - Country:US
Mailing Address - Phone:870-243-4406
Mailing Address - Fax:
Practice Address - Street 1:1461 MUNFORD AVE
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058-6743
Practice Address - Country:US
Practice Address - Phone:901-837-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty