Provider Demographics
NPI:1568850238
Name:GROOVY SMILES PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:GROOVY SMILES PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-764-3883
Mailing Address - Street 1:2425 DAVE WARD DR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8686
Mailing Address - Country:US
Mailing Address - Phone:501-764-3883
Mailing Address - Fax:501-325-1400
Practice Address - Street 1:622 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6852
Practice Address - Country:US
Practice Address - Phone:501-764-3883
Practice Address - Fax:501-325-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty