Provider Demographics
NPI:1609284900
Name:JONESBORO FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:JONESBORO FAMILY DENTAL PLLC
Other - Org Name:JONESBORO FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-935-0111
Mailing Address - Street 1:912 OSLER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4366
Mailing Address - Country:US
Mailing Address - Phone:870-935-0111
Mailing Address - Fax:
Practice Address - Street 1:912 OSLER DR
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4366
Practice Address - Country:US
Practice Address - Phone:870-935-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR39861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty