Provider Demographics
NPI:1598812224
Name:CALVIN B. SUFFRIDGE, DDS, PA
Entity Type:Organization
Organization Name:CALVIN B. SUFFRIDGE, DDS, PA
Other - Org Name:CALVIN B. SUFFRIDGE, DDS, MS, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:BUFORD
Authorized Official - Last Name:SUFFRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-907-6000
Mailing Address - Street 1:8 PARKSTONE CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7086
Mailing Address - Country:US
Mailing Address - Phone:501-907-6000
Mailing Address - Fax:501-907-5664
Practice Address - Street 1:8 PARKSTONE CIR
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7086
Practice Address - Country:US
Practice Address - Phone:501-907-6000
Practice Address - Fax:501-907-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31821223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X097OtherBCBS HEALTH ADVANTAGE
AR1388393OtherUNITED CONCORDIA