Provider Demographics
NPI:1699193938
Name:LAKEWOOD DENTAL CARE
Entity Type:Organization
Organization Name:LAKEWOOD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HIXSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-758-1260
Mailing Address - Street 1:2411 MCCAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7505
Mailing Address - Country:US
Mailing Address - Phone:501-758-1260
Mailing Address - Fax:
Practice Address - Street 1:2411 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7505
Practice Address - Country:US
Practice Address - Phone:501-758-1260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2476122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty