Provider Demographics
NPI:1578151601
Name:MARK W. CHUNN
Entity Type:Organization
Organization Name:MARK W. CHUNN
Other - Org Name:WHITE RIVER DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRONT OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HELWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-698-0900
Mailing Address - Street 1:259 EAGLE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-4232
Mailing Address - Country:US
Mailing Address - Phone:870-698-0900
Mailing Address - Fax:870-698-0332
Practice Address - Street 1:259 EAGLE MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-4232
Practice Address - Country:US
Practice Address - Phone:870-698-0900
Practice Address - Fax:870-698-0332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITE RIVER DENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-05
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR260994631Medicaid