Provider Demographics
NPI:1740423482
Name:DC DENTAL
Entity Type:Organization
Organization Name:DC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TREVOR
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-246-2828
Mailing Address - Street 1:280 PROFESSIONAL PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4232
Mailing Address - Country:US
Mailing Address - Phone:870-246-2828
Mailing Address - Fax:
Practice Address - Street 1:280 PROFESSIONAL PARK DR STE B
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4232
Practice Address - Country:US
Practice Address - Phone:870-246-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty