Provider Demographics
NPI:1639636624
Name:UNIVERSITY SMILE CENTER PLLC
Entity Type:Organization
Organization Name:UNIVERSITY SMILE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-377-3978
Mailing Address - Street 1:820 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2920
Mailing Address - Country:US
Mailing Address - Phone:501-664-1733
Mailing Address - Fax:
Practice Address - Street 1:820 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2920
Practice Address - Country:US
Practice Address - Phone:501-664-1733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty