Provider Demographics
NPI:1568442788
Name:SVENDSEN, JOHN EDWARD (MS, DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:SVENDSEN
Suffix:
Gender:M
Credentials:MS, DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16101 LAGRANDE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9140
Mailing Address - Country:US
Mailing Address - Phone:501-821-6134
Mailing Address - Fax:501-821-6127
Practice Address - Street 1:16101 LAGRANDE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-9140
Practice Address - Country:US
Practice Address - Phone:501-821-6134
Practice Address - Fax:501-821-6127
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR846593OtherUNITED CONCORDIA ID NUMBE
AR58321OtherBCBS ID NUMBER