Provider Demographics
NPI:1679157853
Name:NICOLE POWELL, DDS, PLLC
Entity Type:Organization
Organization Name:NICOLE POWELL, DDS, PLLC
Other - Org Name:HOMETOWN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-268-2000
Mailing Address - Street 1:3206 LANGLEY DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6020
Mailing Address - Country:US
Mailing Address - Phone:501-268-2000
Mailing Address - Fax:501-268-2442
Practice Address - Street 1:3206 LANGLEY DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6020
Practice Address - Country:US
Practice Address - Phone:501-268-2000
Practice Address - Fax:501-268-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR221305608Medicaid
AR267608631Medicaid