Provider Demographics
NPI:1568895548
Name:CENTRE @ 10 DENTAL GROUP
Entity Type:Organization
Organization Name:CENTRE @ 10 DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DRAKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-224-5511
Mailing Address - Street 1:12921 CANTRELL RD
Mailing Address - Street 2:301
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1713
Mailing Address - Country:US
Mailing Address - Phone:501-224-5511
Mailing Address - Fax:501-224-2405
Practice Address - Street 1:12921 CANTRELL RD
Practice Address - Street 2:301
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1713
Practice Address - Country:US
Practice Address - Phone:501-224-5511
Practice Address - Fax:501-224-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty